January 1995

Comparison of APACHE II and III Scoring Systems for Mortality Prediction in Critical Surgical Illness

Author Affiliations

From the Department of Surgery, Cornell University Medical College, New York (NY) Hospital—Cornell Medical Center.

Arch Surg. 1995;130(1):77-82. doi:10.1001/archsurg.1995.01430010079016

Objective:  To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness.

Design:  Prospective cohort study.

Setting:  Surgical intensive care unit of an urban, tertiary-care university hospital.

Participants:  Eight hundred forty-four consecutive patients in the surgical intensive care unit. Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups.

Main Outcome Measures:  Survival to hospital discharge, and survival compared with published normative APACHE II and III databases.

Results:  Mean age was 65.1 ±0.5 years. Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital. The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P<.0001) (range of correlation coefficients,.72 to.86) overall and in all subgroups. Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P<.01) higher overall and in all subgroups.

Conclusions:  In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.(Arch Surg. 1995;130:77-82)