Issn Print: 0265-0215

Publication Date: 2005/05/01


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First year experience of APACHE II scoring in intensive care and high dependency care units in St Lukes Hospital, Malta: A-639

Galea M. Scannura; E. Grech; A. Gera

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Background and Goal of Study: APACHE II scoring is widely used to assess quality of care in intensive care, and to compare performance of different units (1). The aim of the study was introduce ongoing APACHE II scoring and standardised mortality ratio (SMR) calculation in the intensive care and high dependency care unit (ITU/HDU) at St Luke's Hospital, Malta; and to provide baselines against which the performance of future years can be measured.
Materials and Methods: A prospective, consecutive, non-interventional study was carried out over 4 months. Physiological variables were collected at the bedside by the same two people (2). Admission and outcome data was also collected. APACHE II score, predicted mortality and SMR were then calculated retrospectively. One patient was excluded because of missing variables; children less than 16 years old and burns patients were also excluded.
Results and Discussions: 251 patients were included - 106 medical and 145 surgical patients. The SMR for the whole unit (ITU and HDU) was 0.74. Overall performance for surgical patients was better than for medical patients (SMR medical 0.83; surgical 0.60). A trend to worse outcome in older age groups was also observed, with the worst being 60-69 age group (SMR 0.88).
Conclusions: Total ITU/HDU performance was better than expected, with all values being less than 1. The SMR of the unit (0.74) can be used as a baseline for future years The study also indicates a need to investigate subgroups of patients who need increased attention, with the aim to improve outcome. APACHE II scoring is now being done daily for all patients. The plan is to repeat the study comparing outcomes of A&E admissions with ward admissions; and excluding elective post-operative surgical admissions.
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