Apache Iii predictive equations

An APACHE III equation predicts hospital mortality for groups of intensive care admissions by linking first-day patient characteristics to a 17 440-admission reference database. Although these predictions are based on patient outcomes between 1988 and 1990, they have been updated based on outcomes between 1993 and 1996 for over 37 000 intensive care admissions in the United States. Prognostic estimates use the APACHE III score and additional variables to reflect disease and selection for intensive care. The database includes 212 potential diagnoses, and there are weights for 66 specific diagnoses and 12 organ-system-related residual categories (Kna.us.efa/ 1991). Patient selection is accounted for by weights reflecting whether ICU readmission or emergency surgery occurred, location prior to ICU

admission, and hospital length of stay and location prior to ICU admission. These variables are included to control, at least in part, for differences in patient selection and response (or lack of response) to prior therapy, i.e. for selection and lead-time bias. When individual prognostic estimates are aggregated to the unit level, comparisons of actual and predicted outcomes provide a method for assessing ICU performance (Zimmerman ..efa/ 1993). Similar disease-specific predictive models have also been developed to predict hospital mortality and other outcomes for patients with specific conditions such as sepsis and coronary artery bypass surgery.

In addition to hospital mortality, equations incorporating similar but not identical variables are used to predict outcomes which reflect intensive care resource use

(Zim.merman.efa/ 1993). These first-day capabilities include predictions of subsequent intensive care and hospital length of stay, therapeutic intervention score, risk for active life-supporting therapy, frequency of laboratory testing, and duration of mechanical ventilation. Each of these outcomes is predicted on the basis of individual patient and institutional characteristics with reference to the APACHE III database. The length of stay predictions have been updated based on data for the period from 1993 to 1996. Comparisons of actual and predicted outcomes aggregated to the unit level provide a means of assessing ICU efficiency.

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