Comment in:
Resuscitation. 2008 Mar;76(3):488.
Man SY, Chan KM, Wong FY, Wong KY, Yim CL, Mak PS, Kam CW, Lau CC, Lau FL, Graham
CA, Rainer TH.
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong
Kong, Hong Kong SAR, China.
INTRODUCTION: Numerous prognostic predictive models have been developed for
critically ill patients, many of which are primarily designed for use in
intensive care units. The objective of this study was to evaluate the accuracy of
a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring
system in predicting the mortality for critically ill patients managed in
emergency department (ED) resuscitation rooms in Hong Kong. METHOD: A
multi-centre, prospective study was conducted for patients managed in the
resuscitation rooms of the EDs of four major hospitals, including one university
teaching hospital. The primary outcome measure was 14 day all-cause mortality and
the secondary outcome measure was the length of stay in hospital. RESULTS: Of 867
patients recruited between 4 and 30 April 2004, 106 (12.2%) patients died. The
modified APACHE II score was found to be significantly higher in non-survivors
compared to survivors (mean+/-S.D.: 21.2+/-7.7 versus 14.4+/-7.1, p<0.001). The
area under the curve for modified APACHE II in predicting mortality was 0.743
(95% CI, 0.696-0.790). CONCLUSION: The modified APACHE II score is only a
moderate predictor of mortality for critically ill patients managed in the
resuscitation rooms of EDs in Hong Kong. A more ED specific scoring method is
required.