Predictive Performance of Acute Physiological and Chronic Health Evaluation Releases II to IV: A Single New Zealand Centre Experience

Abstract

There is debate in Australia and New Zealand around the appropriate use of illness severity scoring systems in Australasian intensive care units. The international benchmark is the Acute Physiological and Chronic Health Evaluation (APACHE) system. In order to compare the performance of recent APACHE releases, we audited 2080 sequential patients admitted between 1 January 2006 and 31 March 2008 to the Middlemore Hospital intensive care unit in Auckland, New Zealand. We compared the predictive performance of the proprietary APACHE II, IIIh, IIIj and IV releases, and the performance of a 'localised' version of APACHE II containing re-estimated coefficients derived from a legacy dataset (7703 sequential patients admitted between 1 January 1997 and 31 December 2005). Discrimination assessed by receiver operating characteristic curves was highest with the APACHE III and IV releases, and significantly better than the APACHE II releases. Calibration assessed by the Hosmer-Lemeshow statistic was poor with all releases, although it was best with APACHE IV and 'localised' version of the APACHE II release. Overall accuracy assessed by the Brier Mean Probability score and Shapiro's R statistic was best with APACHE IV. Our study suggests the possibility of improved prediction in moving to APACHE IV from older releases, although broader multicentre study within the Australian and New Zealand critical care community is warranted. Our study also suggests that localisation of the APACHE system offers further opportunity to improve prediction, although these improvements may not be major without ground-up development of a new risk prediction model within our local critical care setting.

Performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) in the prediction of hospital mortality in a mixed ICU in Singapore

“…23 Although first-level customisation considerably improved calibration, it remained insufficient to significantly improve calibration accuracy. This is similar to the results of Brinkman et al and Mann et al, 15,24 in which customisation also did not improve calibration accuracy.…”

“…10,13 Evidently, reduction in observed hospital mortality with time due to advances in treatment modalities gradually reduces the discrimination and calibration accuracy of the APACHE II. 14,15 This may account for the discordance of results between our study and those of Lee et al and Chen et al 10,13 Compared to recent studies conducted in other countries, patients in our study had higher disease severity, as evidenced by the higher mean APACHE II score (24.5 versus 17-21). 14,[16][17][18][19][20][21] Similar to recent studies, the APACHE II in our study also had good discriminative validity, that is, 0.756 versus 0.729 to 0.805, 14,[16][17][18][19][20][21] and poor calibration accuracy.…”

“…10,13 Evidently, reduction in observed hospital mortality with time due to advances in treatment modalities gradually reduces the discrimination and calibration accuracy of the APACHE II. 14,15 This may account for the discordance of results between our study and those of Lee et al and Chen et al 10,13…”

Acute Physiology and Chronic Health Evaluation (APACHE) II Score – the Clinical Predictor in Neurosurgical Intensive Care Unit

“…The familiarity is achieved because of its less variables and no calculation converted for any sea levels affected ( 4 , 10 ). The APACHE II score can compare and benchmark for the effectiveness, efficacy and quality matter of each unit individually ( 11 , 12 ). Nonetheless, the qualified systematic database indicating APACHE II score, i.e.…”

Material Y Métodos

“…Se ha utilizado la escala APACHE II por ser empleada de manera rutinaria en nuestro país. Aunque quizá no sea la mejor de las escalas de gravedad actualmente en uso (Mann et al 2012;Civetta et al 1992), el amplísimo número de registros compensa la variabilidad interindividual en las observaciones.…”