Severity and prognosis in intensive care: prospective application of the Apache II Index

Detalhes bibliográficos
Autor(a) principal: Costa, Joel Isidoro
Data de Publicação: 1999
Outros Autores: Amaral, José Luiz Gomes do [UNIFESP], Munechika, Masashi [UNIFESP], Juliano, Yara [UNIFESP], Bezerra Filho, José Gomes
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1590/S1516-31801999000500005
http://repositorio.unifesp.br/handle/11600/827
Resumo: CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.
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spelling Severity and prognosis in intensive care: prospective application of the Apache II IndexSeverityMortalityIntensive CareAPACHE IIGravidadeMortalidadeMedicina IntensivaAPACHE IICONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.CONTEXTO: É necessário que cada UTI possa avaliar seu próprio desempenho no contexto global da assistência médica e possa ser igualmente avaliada pela instituição em que está inserida. Existem mecanismos avaliadores do tratamento intensivo, amplamente reconhecidos pela literatura médica mundial. OBJETIVOS: Estudar a evolução de grupos de doentes críticos e comparar as respectivas taxas de mortalidade real e esperada. TIPO DE ESTUDO: Estudo prospectivo da evolução de pacientes. LOCAL: Unidade de cuidados terciários de um hospital-escola durante 13 meses. (UTI da Anestesiologia da Escola Paulista de Medicina). PARTICIPANTES: 520 pacientes, agrupados segundo sexo, idade e caráter da internação. TESTE DIAGNÓSTICO: Para avaliação da gravidade e previsão de mortalidade, foi aplicado nos três grupos - doentes não-cirúrgicos, cirúrgicos em urgências e cirúrgicos eletivos - o índice prognóstico APACHE II modificado. VARIÁVEIS ESTUDADAS: Índice APACHE II. RESULTADOS: O índice permitiu a estratificação e o cálculo do risco de óbito de grupos de doentes. A taxa de mortalidade observada foi superior à esperada (28,5% e 23,6%, respectivamente), com diferença estatisticamente significante, sendo que a razão mortalidade observada/mortalidade esperada foi 1,20. Dos pacientes com escore acima de 25, 89% evoluíram para óbito. Os grupos de pior evolução foram, pela ordem: pacientes não cirúrgicos, cirúrgicos em urgências e cirúrgicos eletivos; a mortalidade geral observada foi superior à esperada. CONCLUSÕES: A aplicação do índice serviu para estratificar grupos de pacientes críticos de acordo com a sua gravidade.Universidade Federal de São Paulo (UNIFESP)Federal University of CearáUNIFESP, Escola Paulista de MedicinaSciELOAssociação Paulista de Medicina - APMUniversidade Federal de São Paulo (UNIFESP)Federal University of CearáCosta, Joel IsidoroAmaral, José Luiz Gomes do [UNIFESP]Munechika, Masashi [UNIFESP]Juliano, Yara [UNIFESP]Bezerra Filho, José Gomes2015-06-14T13:24:55Z2015-06-14T13:24:55Z1999-09-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion205-214application/pdfhttp://dx.doi.org/10.1590/S1516-31801999000500005São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 117, n. 5, p. 205-214, 1999.10.1590/S1516-31801999000500005S1516-31801999000500005.pdf1516-3180S1516-31801999000500005http://repositorio.unifesp.br/handle/11600/827engSão Paulo Medical Journalinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-06T06:20:22Zoai:repositorio.unifesp.br/:11600/827Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-06T06:20:22Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Severity and prognosis in intensive care: prospective application of the Apache II Index
title Severity and prognosis in intensive care: prospective application of the Apache II Index
spellingShingle Severity and prognosis in intensive care: prospective application of the Apache II Index
Costa, Joel Isidoro
Severity
Mortality
Intensive Care
APACHE II
Gravidade
Mortalidade
Medicina Intensiva
APACHE II
title_short Severity and prognosis in intensive care: prospective application of the Apache II Index
title_full Severity and prognosis in intensive care: prospective application of the Apache II Index
title_fullStr Severity and prognosis in intensive care: prospective application of the Apache II Index
title_full_unstemmed Severity and prognosis in intensive care: prospective application of the Apache II Index
title_sort Severity and prognosis in intensive care: prospective application of the Apache II Index
author Costa, Joel Isidoro
author_facet Costa, Joel Isidoro
Amaral, José Luiz Gomes do [UNIFESP]
Munechika, Masashi [UNIFESP]
Juliano, Yara [UNIFESP]
Bezerra Filho, José Gomes
author_role author
author2 Amaral, José Luiz Gomes do [UNIFESP]
Munechika, Masashi [UNIFESP]
Juliano, Yara [UNIFESP]
Bezerra Filho, José Gomes
author2_role author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
Federal University of Ceará
dc.contributor.author.fl_str_mv Costa, Joel Isidoro
Amaral, José Luiz Gomes do [UNIFESP]
Munechika, Masashi [UNIFESP]
Juliano, Yara [UNIFESP]
Bezerra Filho, José Gomes
dc.subject.por.fl_str_mv Severity
Mortality
Intensive Care
APACHE II
Gravidade
Mortalidade
Medicina Intensiva
APACHE II
topic Severity
Mortality
Intensive Care
APACHE II
Gravidade
Mortalidade
Medicina Intensiva
APACHE II
description CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.
publishDate 1999
dc.date.none.fl_str_mv 1999-09-02
2015-06-14T13:24:55Z
2015-06-14T13:24:55Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1590/S1516-31801999000500005
São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 117, n. 5, p. 205-214, 1999.
10.1590/S1516-31801999000500005
S1516-31801999000500005.pdf
1516-3180
S1516-31801999000500005
http://repositorio.unifesp.br/handle/11600/827
url http://dx.doi.org/10.1590/S1516-31801999000500005
http://repositorio.unifesp.br/handle/11600/827
identifier_str_mv São Paulo Medical Journal. Associação Paulista de Medicina - APM, v. 117, n. 5, p. 205-214, 1999.
10.1590/S1516-31801999000500005
S1516-31801999000500005.pdf
1516-3180
S1516-31801999000500005
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv São Paulo Medical Journal
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 205-214
application/pdf
dc.publisher.none.fl_str_mv Associação Paulista de Medicina - APM
publisher.none.fl_str_mv Associação Paulista de Medicina - APM
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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