Abstract
Objective: To determine if an increase in the third-ICU-day acute physiology score (APS) of the APACHE (acute physiology and chronic health evaluation) III prognostic system can identify potentially ineffective care. Design: Retrospective cohort study. Setting: Academic medical center. Patients: Adult patients with first-ICU-day predicted mortality rate ≥ 80%. Measurements: Demographics, ICU admission source, admission type, ICU admission diagnosis, first- and third-ICU-day APSs, APACHE III score, APACHE III-predicted hospital mortality, hospital discharge status, 100-day survival, and ICU and hospital length of stay. Results: A total of 302 patients (age [mean ± SD], 64.7 ± 15.8 years; 54.3% male gender) were included in the study. Respiratory failure was the most common reason for ICU admission. Nonoperative admissions accounted for 94.7%. The first- and third-ICU-day APSs were 106.8 ± 19.8 and 70.5 ± 29.9, respectively. The first- and third-ICU-day predicted hospital mortality rates were 87.8 ± 5.3% and 86.5 ± 14.8%, respectively. The hospital mortality rate was 61.3%, and the 100-day survival rate 28.5%. The third-ICU-day APS was higher than the first-ICU-day APS in 34 patients (11.3%). Only 2 of these 34 patients (6%) survived to hospital discharge, compared to 115 of 268 patients (43%) without an increase in APS (p <0.0001). Of the two hospital survivors with increased APS, only one patient survived 100 days after hospital discharge. In predicting 100-day mortality, the sensitivity of an increase in the third-ICU-day APS was 15.3% (95% confidence interval, 11.1 to 20.7%), specificity was 98.8% (95% confidence interval, 93.7 to 99.8%), positive predictive value was 97.1% (95% confidence interval, 85.1 to 99.5%), and negative predictive value was 31.7% (95% confidence interval, 26.4 to 37.5%). Conclusions: A higher APS on the third ICU day, compared to the first ICU day, identifies potentially ineffective care in patients with the first-day predicted hospital mortality rate ≥ 80%.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1905-1909 |
| Number of pages | 5 |
| Journal | Chest |
| Volume | 126 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2004 |
| Externally published | Yes |
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Keywords
- Acute physiology and chronic health evaluation
- Hospital mortality
- ICU
- Length of stay
- Medical futility
- Prognosis
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Identifying potentially ineffective care in the sickest critically III patients on the third ICU day. / Afessa, Bekele; Keegan, Mark T.; Mohammad, Zulfiqar; Finkielman, Javier D.; Peters, Steve G.
In: Chest, Vol. 126, No. 6, 12.2004, p. 1905-1909.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Identifying potentially ineffective care in the sickest critically III patients on the third ICU day
AU - Afessa, Bekele
AU - Keegan, Mark T.
AU - Mohammad, Zulfiqar
AU - Finkielman, Javier D.
AU - Peters, Steve G.
PY - 2004/12
Y1 - 2004/12
N2 - Objective: To determine if an increase in the third-ICU-day acute physiology score (APS) of the APACHE (acute physiology and chronic health evaluation) III prognostic system can identify potentially ineffective care. Design: Retrospective cohort study. Setting: Academic medical center. Patients: Adult patients with first-ICU-day predicted mortality rate ≥ 80%. Measurements: Demographics, ICU admission source, admission type, ICU admission diagnosis, first- and third-ICU-day APSs, APACHE III score, APACHE III-predicted hospital mortality, hospital discharge status, 100-day survival, and ICU and hospital length of stay. Results: A total of 302 patients (age [mean ± SD], 64.7 ± 15.8 years; 54.3% male gender) were included in the study. Respiratory failure was the most common reason for ICU admission. Nonoperative admissions accounted for 94.7%. The first- and third-ICU-day APSs were 106.8 ± 19.8 and 70.5 ± 29.9, respectively. The first- and third-ICU-day predicted hospital mortality rates were 87.8 ± 5.3% and 86.5 ± 14.8%, respectively. The hospital mortality rate was 61.3%, and the 100-day survival rate 28.5%. The third-ICU-day APS was higher than the first-ICU-day APS in 34 patients (11.3%). Only 2 of these 34 patients (6%) survived to hospital discharge, compared to 115 of 268 patients (43%) without an increase in APS (p <0.0001). Of the two hospital survivors with increased APS, only one patient survived 100 days after hospital discharge. In predicting 100-day mortality, the sensitivity of an increase in the third-ICU-day APS was 15.3% (95% confidence interval, 11.1 to 20.7%), specificity was 98.8% (95% confidence interval, 93.7 to 99.8%), positive predictive value was 97.1% (95% confidence interval, 85.1 to 99.5%), and negative predictive value was 31.7% (95% confidence interval, 26.4 to 37.5%). Conclusions: A higher APS on the third ICU day, compared to the first ICU day, identifies potentially ineffective care in patients with the first-day predicted hospital mortality rate ≥ 80%.
AB - Objective: To determine if an increase in the third-ICU-day acute physiology score (APS) of the APACHE (acute physiology and chronic health evaluation) III prognostic system can identify potentially ineffective care. Design: Retrospective cohort study. Setting: Academic medical center. Patients: Adult patients with first-ICU-day predicted mortality rate ≥ 80%. Measurements: Demographics, ICU admission source, admission type, ICU admission diagnosis, first- and third-ICU-day APSs, APACHE III score, APACHE III-predicted hospital mortality, hospital discharge status, 100-day survival, and ICU and hospital length of stay. Results: A total of 302 patients (age [mean ± SD], 64.7 ± 15.8 years; 54.3% male gender) were included in the study. Respiratory failure was the most common reason for ICU admission. Nonoperative admissions accounted for 94.7%. The first- and third-ICU-day APSs were 106.8 ± 19.8 and 70.5 ± 29.9, respectively. The first- and third-ICU-day predicted hospital mortality rates were 87.8 ± 5.3% and 86.5 ± 14.8%, respectively. The hospital mortality rate was 61.3%, and the 100-day survival rate 28.5%. The third-ICU-day APS was higher than the first-ICU-day APS in 34 patients (11.3%). Only 2 of these 34 patients (6%) survived to hospital discharge, compared to 115 of 268 patients (43%) without an increase in APS (p <0.0001). Of the two hospital survivors with increased APS, only one patient survived 100 days after hospital discharge. In predicting 100-day mortality, the sensitivity of an increase in the third-ICU-day APS was 15.3% (95% confidence interval, 11.1 to 20.7%), specificity was 98.8% (95% confidence interval, 93.7 to 99.8%), positive predictive value was 97.1% (95% confidence interval, 85.1 to 99.5%), and negative predictive value was 31.7% (95% confidence interval, 26.4 to 37.5%). Conclusions: A higher APS on the third ICU day, compared to the first ICU day, identifies potentially ineffective care in patients with the first-day predicted hospital mortality rate ≥ 80%.
KW - Acute physiology and chronic health evaluation
KW - Hospital mortality
KW - ICU
KW - Length of stay
KW - Medical futility
KW - Prognosis
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UR - http://www.scopus.com/inward/citedby.url?scp=10444263783&partnerID=8YFLogxK
U2 - 10.1378/chest.126.6.1905
DO - 10.1378/chest.126.6.1905
M3 - Article
VL - 126
SP - 1905
EP - 1909
JO - Chest
JF - Chest
SN - 0012-3692
IS - 6
ER -