Severity and prognosis in intensive care: prospective application of the Apache II Index
Autor(a) principal: | |
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Data de Publicação: | 1999 |
Outros Autores: | , , , |
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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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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1814268459796660224 |