Apache Iii and prognosis for individual patients

Prognostic systems will never predict an individual's death or survival with 100 per cent specificity. Serious diseases and high severity scores do not indicate absolute irreversibility, and a less severe disease and low severity scores do not guarantee against unforeseen complications or chance mortality. Although mortality predictions using the first-day APACHE III equation are as accurate as those based on physician judgment, clinicians recognize that it is rarely possible to estimate prognosis accurately for an individual patient after 1 day of intensive care. The ability to predict an individual patient's probability of survival typically depends on assessment of how he or she responds to therapy over time.

The APACHE III prognostic system uses daily assessment of acute physiology scores as a measure of response to therapy over time (Wagner. ...efa/ 1994). An individual's probability of hospital mortality is updated daily using a series of equations based on the patient's status on ICU day 1, on physiological status during the current day, and on physiological trends over the most recent 24 h.

These daily prognostic estimates can and are being used to assist in making decisions about individual patients. With the aid of modern clinical information systems, physicians are using these probabilities at the bedside in much the same way they use the results of laboratory tests. However, unlike the results of a blood test which is drawn directly from the patient, a risk probability is derived indirectly from patient characteristics and a reference database. Thus clinicians using this information must consider, as they do in interpreting laboratory tests or other reports, the impact of missing values, data entry errors, and other sources of bias. They must also consider the availability of new therapies and understand that the confidence interval for each estimate widens for each succeeding day, that trends are more important than absolute values, and that some prognostic factors and indicators of response to therapy are not measured by the physiological variables.

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