Journal article
An automated computerized critical illness severity scoring system derived from APACHE III: modified APACHE
Journal of Critical Care, Vol.48, pp.237-242
12/2018
DOI: 10.1016/j.jcrc.2018.09.005
PMID: 30243204
Abstract
To evaluate the performance of an automated computerized ICU severity scoring derived from the APACHE III. Within a retrospective cohort of patients admitted to Veterans Health Administration ICUs between 2009 and 2015, we created an automated illness severity score(modified APACHE or mAPACHE), that we extracted from the electronic health records, using the same scoring as the APACHE III excluding the Glasgow Coma Scale, urine output, arterial blood gas components of APACHE III. We assessed the mAPACHE discrimination by using the area under the curve(AUC), and calibration by using the Hosmer-Lemeshow test and calculating the difference between observed and expected mortality across equal-sized risk deciles for death. The ICU and 30-day mortality was 5.07% of 7.82%, respectively (n = 490,955 patients). The AUC of mAPACHE for ICU and 30-day mortality was 0.771 and 0.786, respectively. The Hosmer-Lemeshow test was significant for both ICU and 30-day mortality (p < .001). The absolute difference between observed and expected mortality did not exceed ±1.53% across equal-sized deciles of risk for death. The AUC for ICU mortality was >0.7 in all admission diagnosis categories except in endocrine, respiratory, and sepsis. The AUC for 30-day mortality was >0.7 in every category. mAPACHE has adequate performance to predict mortality. •Traditional critical illness severity scoring systems are not easily obtainable.•Admission urine output, Glasgow coma scale and blood gases are not usually available.•We created a critical illness severity score by selecting APACHE III variables.•mAPACHE has good to very good discrimination to predict ICU and 30-day mortality.•mAPACHE can be used in almost every ICU with no specialized personnel or software.
Details
- Title: Subtitle
- An automated computerized critical illness severity scoring system derived from APACHE III: modified APACHE
- Creators
- Spyridon Fortis - University of Iowa, Internal MedicineAmy M.J O'Shea - University of Iowa, General Internal MedicineBrice F Beck - Iowa City VA Health Care SystemRajeshwari Nair - University of Iowa, General Internal MedicineMichihiko Goto - University of Iowa, Internal MedicinePeter J Kaboli - University of Iowa, General Internal MedicineEli N Perencevich - University of Iowa, Internal MedicineHeather S Reisinger - University of Iowa, General Internal MedicineMary V Sarrazin - University of Iowa, General Internal Medicine
- Resource Type
- Journal article
- Publication Details
- Journal of Critical Care, Vol.48, pp.237-242
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jcrc.2018.09.005
- PMID
- 30243204
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Grant note
- DOI: 10.13039/100000738, name: Department of Veterans Affairs; DOI: 10.13039/100007217, name: Health Services Research and Development; DOI: 10.13039/100000738, name: Department of Veterans Affairs
- Language
- English
- Date published
- 12/2018
- Academic Unit
- Infectious Diseases; Health Management and Policy; Epidemiology; Center for Social Science Innovation; Internal Medicine
- Record Identifier
- 9983779489902771
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