Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Introduction: Physiologic scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Simplified Acute Physiology Score (SAPS II) measure illness severity and provides mortality risk probabilities for intensive care unit (ICU) patients. The Emergency Department (ED) is a major contributor of ICU admissions who frequently require critical care in the ED. This study evaluates the use of APACHE II and SAPS II in assessing the impact of critical care delivery in the ED.
Methods: In a prospective, consecutive case series, adult patients presenting to a large urban ED and admitted to the medical ICU over a 12-month period were studied. APACHE II and SAPS II scores and predicted mortality (pred. mort.) were calculated at ED admission, ED discharge, and after 24 hours in the ICU. Group average scores and pred. mort. was compared using 2-tailed, paired student's t-test.
Results: Eighty-one patients were enrolled with a mean age of 62.8 +/- 19.3 years. ED length of stay was 6.4 +/- 2.2 hours and the total hospital length of stay was 297.7 +/- 312.6 hours. The actual in-hospital mortality was 28.0%. (Table 1)
Conclusions: There is a significant decrease in physiologic scores and predicted in-hospital mortality during ED stay. Mortality predictions at ED admission, ED discharge and after 24 hours in the ICU progressively approximate actual in-hospital mortality. In the treatment of critically ill patients. ED intervention may have the greatest impact on outcome in some institutions.
