Accuracy and reliability of APACHE II scoring in two intensive care units : Problems and pitfalls in the use of APACHE II and suggestions for improvement

Acute Physiology and Chronic Health Evaluation (APACHE) II scoring is widely used as an index of illness severity, for outcome prediction, in research protocols and to assess intensive care unit performance and quality of care. Despite its widespread use, little is known about the reliability and va...

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Published inAnaesthesia Vol. 56; no. 1; pp. 47 - 50
Main Authors POIDERMAN, K. H, GIRBES, A. R. J, THIJS, L. G, VAN SCHIJNDEL, R. J. M. Strack
Format Journal Article
LanguageEnglish
Published Oxford Blackwell 2001
Subjects
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
APACHE
Biological and medical sciences
Guideline Adherence
Humans
Intensive care medicine
Intensive Care Units - standards
Intensive Care Units - statistics & numerical data
Medical Records Systems, Computerized
Medical sciences
Middle Aged
Miscellaneous
Observer Variation
Reproducibility of Results
Retrospective Studies
Human
Intensive care
Severity score
Evaluation scale
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Summary:Acute Physiology and Chronic Health Evaluation (APACHE) II scoring is widely used as an index of illness severity, for outcome prediction, in research protocols and to assess intensive care unit performance and quality of care. Despite its widespread use, little is known about the reliability and validity of APACHE II scores generated in everyday clinical practice. We retrospectively re-assessed APACHE II scores from the charts of 186 randomly selected patients admitted to our medical and surgical intensive care units. These 'new' scores were compared with the original scores calculated by the attending physician. We found that most scores calculated retrospectively were lower than the original scores; 51% of our patients would have received a lower score, 26% a higher score and only 23% would have remained unchanged. Overall, the original scores changed by an average of 6.4 points. We identified various sources of error and concluded that wide variability exists in APACHE II scoring in everyday clinical practice, with the score being generally overestimated. Accurate use of the APACHE II scoring system requires adherence to strict guidelines and regular training of medical staff using the system.
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ISSN:0003-2409
1365-2044
DOI:10.1046/j.1365-2044.2001.01763.x