Role of acute physiology and chronic health evaluation II scoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit
N. P. Chhangani, Minhas Amandeep, Sandeep Choudhary, Vidit Gupta, Vishnu Goyal
Acute Physiology and Chronic Health Evaluation score, calibration, critically ill, discrimination, Pediatric Intensive Care Unit
Citation Information :
Chhangani NP, Amandeep M, Choudhary S, Gupta V, Goyal V. Role of acute physiology and chronic health evaluation II scoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit. Indian J Crit Care Med 2015; 19 (8):462-465.
Objective: This study was conducted to validate the use of Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system in pediatric population in predicting the risk of mortality and to compare the predicted death rate (using APACHE II) with the actual death rate of the patients. Design: Hospital-based prospective study. Setting: Tertiary care Pediatric Intensive Care Unit (PICU) in Western Rajasthan, India. Methods: A total of 100 critically ill children between 1 and 18 years of age admitted to PICU and fulfilling the inclusion criteria were enrolled. APACHE II score was calculated in each patient on the day of admission. The predicted mortality was calculated on the basis of this score. Results: The mean APACHE II score was 21.35 ± 5.76. Mean APACHE II score among the survivors was 16.60 ± 6.12, and mean APACHE II score among the nonsurvivors was 26.11 ± 5.41, and the difference was statistically significant (P = 0.00). The area under the receiver operating characteristic curve for APACHE II score was found to be 0.889 (P = 0.008) indicating good discrimination. Conclusion: APACHE II scoring system has a good discrimination and calibration when applied to a pediatric population.
Gregoire G, Russel JA. Assessment of severity of illness. In: Hall JB, Schimdt GA, Wood LD, editors. Principles of Critical Care. New York: McGraw Hill; 1998. p. 57-69.
Norris C, Jacobs P, Rapoport J, Hamilton S. ICU and non-ICU cost per day. Can J Anaesth 1995;42:192-6.
Chalfin DB, Cohen IL, Lambrinos J. The economics and cost-effectiveness of critical care medicine. Intensive Care Med 1995;21:952-61.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Wong DT, Knaus WA. Predicting outcome in critical care: The current status of the APACHE prognostic scoring system. Can J Anaesth 1991;38:374-83.
Marra AR, Bearman GM, Wenzel RP, Edmond MB. Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa. BMC Infect Dis 2006;6:132.
Vasilyeva IV, Shvirev SL, Arseniev SB, Zarubina TV. Prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS in decision support of treatment children with severe mechanical trauma. Stud Health Technol Inform 2013;190:59-61.
Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult Intensive Care Units. Crit Care Clin 2007;23:639-58.
Lee BH, Inui D, Suh GY, Kim JY, Kwon JY, Park J, et al. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: Multi-centered prospective observational study. Crit Care 2012;16:R33.
Haque A, Bano S. Improving outcome in Pediatric Intensive Care Unit in academic hospital in Pakistan. Pak J Med Sci 2009;25:605-8.
El Halal MG, Barbieri E, Filho RM, Trotta Ede A, Carvalho PR. Admission source and mortality in a Pediatric Intensive Care Unit. Indian J Crit Care Med 2012;16:81-6.
Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V. Prediction of mortality by application of PRISM score in Intensive Care Unit. Indian Pediatr 2001;38:714-9.
Garros D, Rosychuk RJ, Cox PN. Circumstances surrounding end of life in a Pediatric Intensive Care Unit. J Am Acad Pediatr 2003;112:E371.
Kipper DJ, Piva JP, Garcia PC, Einloft PR, Bruno F, Lago P, et al. Evolution of the medical practices and modes of death on Pediatric Intensive Care Units in southern Brazil. Pediatr Crit Care Med 2005;6:258-63.
Kim JY, Lim SY, Jeon K, Koh Y, Lim CM, Koh SO, et al. External validation of the Acute Physiology and Chronic Health Evaluation II in Korean Intensive Care Units. Yonsei Med J 2013;54:425-31.
Turner JS, Morgan CJ, Thakrar B, Pepper JR. Difficulties in predicting outcome in cardiac surgery patients. Crit Care Med 1995;23:1843-50.
Adesunkanmi AR, Oseni SA, Adejuyigbe O, Agbakwuru EA. Acute generalized peritonitis in African children: Assessment of severity of illness using modified APACHE II score. ANZ J Surg 2003;73:275-9.
Tang CH, Yang CM, Chuang CY, Chang ML, Huang YC, Huang CF. A comparative study of clinical severity scoring systems in ICUs in Taiwan. Tzu Chi Med J 2005;17:239-45.
Nguyen HB, Banta JE, Cho TW, Van Ginkel C, Burroughs K, Wittlake WA, et al. Mortality predictions using current physiologic scoring systems in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. Shock 2008;30:23-8.
Ratanarat R, Thanakittiwirun M, Vilaichone W, Thongyoo S, Permpikul C. Prediction of mortality by using the standard scoring systems in a medical Intensive Care Unit in Thailand. J Med Assoc Thai 2005;88:949-55.
Livingston BM, MacKirdy FN, Howie JC, Jones R, Norrie JD. Assessment of the performance of five intensive care scoring models within a large Scottish database. Crit Care Med 2000;28:1820-7.
Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian Intensive Care Unit patients. Crit Care Med 1995;23:1177-83.