Browse > Article

Comparing the Performance of Three Severity Scoring Systems for ICU Patients: APACHE III, SAPS II, MPM II  

Kwon, Young-Dae (Department of Social and Preventive Medicine College of Medicine Sungkyunkwan University)
Hwang, Jeong-Hae (Research Department, Health Insurance Review Agency)
Kim, Eun-Kyung (School of Nursing, Eulji University)
Publication Information
Journal of Preventive Medicine and Public Health / v.38, no.3, 2005 , pp. 276-282 More about this Journal
Abstract
Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).
Keywords
Intensive care units(ICUs); Acute Physiology and Chronic Health Evaluation(APACHE); Calibration; Mortality;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Shim A. Clinical survey of patients of the Intensive care unit in Wonju Christian Hospital. Korean J Anesthesiol 1994; 1(27): 84-89 (Korean)
2 Thibault GE, Mulley AG, Barnett GO. Medical intensive care: Indications, interventions and outcome. N Engl J Med 1980; 302: 938   DOI   PUBMED   ScienceOn
3 Laurent GG, Turner MO, Andrew D. Rating the quality of intensive care units: Is it a function of the intensive care unit scoring system? Crit Care Med 2002; 30(9): 1976- 1982   DOI   ScienceOn
4 Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score(SAPS II) based on a European/North Americal multicenter study. JAMA 1993; 270: 2957- 2963   DOI   ScienceOn
5 Castella X, Artiga A, Bion J, Kari A. A comparison of severity of illness scoring systems for intensive care unit patients: results of multicenter, multinational study. Crit Care Med 1995; 23(8): 1327-1335   DOI   ScienceOn
6 Lee JH, Back KJ, Han SB, Ahn ST, Shin DW, Kim AJ, Kim JS. Mortality analysis of intensive care units patients using mortality probability models(MPM II). J Traumatol 2001; 14(2): 101-107 (Korean)
7 Guiguet M, Blot F, escudier B, Antoun S, Leclercq B, Nitenber G. Severity illness scores for neutropenic patients in an intensive care unit: which is the best predictor? Do multiple assessment times improve the predictive value? Crit Care Med 1998; 26: 488-493   DOI   ScienceOn
8 Schellongowski P, Benesch M, Lang T, Traunmuller F, Zauner C, Laczika K, Locker GJ, Frass M, Staudinge T. Comparison of three severity score for critically ill cancer patients. Intensive Care Med 2004; 30(3): 430-436   DOI   ScienceOn
9 Carson SS, Bach PB. Predicting mortality in patients suffering from prolonged critical illness: an assessment of four severity-of-illness measures. Chest 2001; 120: 928-933   DOI   ScienceOn
10 Rafkin HS, Hoyt JW. Objective data and quality assurance programs: current and future trends. Crit Care Clinics 1994; 10(1): 157
11 Patel PA, Grant BJB. Application of mortality prediction systems to individual intensive care units. Intensive Care Med 1999; 25: 977-982   DOI   ScienceOn
12 Wong DT, Crofts SL, Gomez M. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995; 23: 1177- 1183   DOI   ScienceOn
13 Knaus WA, Zimmerman JE, Wagner DP. APACHE-acute physiology and chronic health evaluation : A physiologically based classificatio n system. Crit Care Med 1981; 9: 591-597   DOI   PUBMED   ScienceOn
14 Shortell SM, Zimmerman JE, Rousseau DM. The performance of intensive care units: does good management make a difference? Med Care 1994; 32: 508-525   DOI   ScienceOn
15 Sicignano A, Giudici D. Customization of SAPS II for the assessment of severity in Italian ICU patients. Minerva Anesthesiol 2000; 66: 139-145
16 Rue M, Artigas A, Alvarez M. Performance of the mortality probability models(MPM II) in assessing severity of illness during the first week in the intensive care unit. Crit Care Med 2000; 28: 2819-2824   DOI   ScienceOn
17 Knaus WA, Wagner DP, Draper EA, Zimmerm an JE, Bergner M, Bastos PG. The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adult. Chest 1991; 100(6): 1619-1636   DOI   ScienceOn
18 Hall JB, Schmid GA, Wood LD. Principle of critical care. New York: McGraw-Hill Inc. ; 1992. p. 551-557
19 Cullen DJ, Chernow B. Predicting outcome in critically ill patients. Crit Care Med 1994; 22: 1345-1348   DOI   PUBMED   ScienceOn
20 Groeger JS, Lemeshow P, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK. Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability mortality model. J Clin Oncol 1998; 16: 761-770
21 Moreno R, Morians P. Outcome prediction in intensive care: Its of a prospective, multicenter, Portuguese study. Intensive Care Med 1997; 23: 177-186   DOI   ScienceOn
22 Teres D, Lemeshow S, Aurunin JS. Validation of the mortality prediction model for ICU patients. Crit Care Med 1987; 15: 208-212   DOI   PUBMED   ScienceOn
23 Sculier JP, Paesmans M, Markiewicz E, Berghmans T. Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 2000; 28: 2786-2792   DOI   ScienceOn
24 Lee KO, Shin HJ, Park HA, Jung HM, Lee MH, Choi EH, Lee JM. Kim UJ, Sim YK, Park GJ. Patient severity classification in a medical ICU using APACHE III and patient severity classification tool. J Korean Acad Nurs 2000; 30(5): 1243-1253 (Korean)
25 Knaus WA, Draper EA, Wagner DP, Zimmerm an JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13(10): 818-829   DOI   PUBMED   ScienceOn
26 Le Gall JR, Loiral P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Viller D. A simplified acute physiology score for ICU patients. Crit Care Med 1984 ; 12 : 975-977   DOI   PUBMED   ScienceOn
27 Lemeshow S, Teres D, Klar J. Mortality probability models(MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270: 2957-2963   DOI   ScienceOn
28 Zimmerman JE. The APACHE III study design: Analytic plan for evaluation of severity and outcome. Crit Care Med 1989; 17: S169- 221   DOI   ScienceOn
29 Beck DH, Taylor BL, Millar B. Prediction of outcome from intensive care: A prospective cohort study comparing APACHE II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 1997; 25: 9- 15   DOI   ScienceOn
30 Castella K, Artigas A, Bion J, Kari A & The European/North American Severity Study Group. A comparison of severity of illness scoring systems for intensive care unit patients of multicenter, multinational study. Crit Car Med 1995; 23(8): 1327-1335   DOI   ScienceOn
31 Reina A, Vazquez G, Aguayo E, Bravo I, Colmenero M, Bravo M. Mortality discriminat ion in acute myocardial infarction: comparison between APACHE III & SAPS II prognosis system. Intensive Care Med 1997; 23: 326-330   DOI   ScienceOn
32 Lee DH, No MY, Kim BS. Interhospital comparison of outcome from intensive care unit with APACHE III scoring system. Korean J Prev Med 1994; 27(3): 437-445 (Korean)
33 Iezzoni LI. The risk adjustment. JAMA 1997; 278(19): 1600-1607   DOI   PUBMED   ScienceOn
34 Cho KJ. The general analysis of the patients in intensive care unit by severity systems of an university hospital in Seoul [dissertation]. Koea: Seoul National University; 1991 (Korean)
35 Koh BY. Prediction model for in-hospital mortality of patients visited emergency room with acute myocardial infarction [dissertation]. Korea: Chung-ang University; 2002 (Korean)
36 Nunn JF, Milledge JS, Singaraya J. Survival of patients ventilated in an intensive therapy unit. BMJ 1979; 285: 1525
37 Park YS. A study on correlation of clinical process indicator and mortality after severity adjustment [dissertation]. Korea: Korea University; 1998 (Korean)
38 Lemeshow S, Teres D, Avrunin JS, Gage RW. Refining intensive care outcome prediction by using changing probabilities of mortality. Crit Care Med 1988; 16: 470-477   DOI   PUBMED   ScienceOn
39 Scneff M, Knaus WA. Predicting patient outcome from intensive care: A guide to APACHE, MPM, SAPS, PRISM and other prognostic scoring system. J Intensive Care Med 1990; 5(1): 33-52   DOI