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CORRELATION BETWEEN APACHE II SCORE, MORTALITY, AND LENGTH OF STAY IN THE FIRST 24 HOURS OF SHOCK IN INTENSIVE CARE UNIT (ICU) PATIENTS

Coney Island Hospital, Brooklyn, NY

PURPOSE: Shock is a life threatening condition commonly encountered in intensive care unit(ICU) patients. The APACHE II (acute physiology and chronic health evaluation) is used widely for predicting probability of hospital mortality and length of stay in the ICU. We sought to find mortality rate in patients with shock with various APACHE II scores and compared with national data.

METHODS: We reviewed data from medical records of patients admitted to ICU and non-ICU at Coney Island hospital from June 2000 to June 2002. We collected data regarding patients profile, co-morbidities, clinical presentation, etiology of shock, length of ICU stay, duration of hospital stay and mortality. APACHE II forms were available to all ICU residents within 24 hours of admission, and a score was assigned to them. 86 patients were stratified according to etiology of shock as septic (65/86), cardiogenic (16/86) and hypovolemic (5/86). Admissions were stratified by ICU LOS into three groups: <5, 5 –10 and >10 days.

RESULTS: Short-stay patients (ICU LOS < or = 5 days) accounted for 26% of total admissions but consumed <10% of total ICU days. Long-stay patients (ICU LOS > or = 10 days) accounted for 48% of total admissions but consumed 60% of total ICU days. The mortality for long-stay patients approached 92%.

CONCLUSION: Despite the rise in observed and predicted mortality with APACHE II score, predicted mortality did not correlate with observed mortality for critically ill patients. Patients with ICU LOS > or = 10 days accounted for 48% of total admissions but consumed 60% of total ICU days.

CLINICAL IMPLICATIONS: Identification of patients with prolonged ICU LOS who would ultimately die in the ICU may lead to earlier withdrawal of therapy in these patients, resulting in a substantial reduction in suffering and cost savings. Our study has provided crucial input for the study of strategic change towards more optimal utilization of scarce ICU resources.

DISCLOSURE: Muhammad Rehman, None.