Sebastian Böttger | PubMed Health

PubMed2002

Automatic calculation of a modified APACHE II score using a patient data management system (PDMS).

OBJECTIVE: To investigate a fully automated and modified APACHE II score calculation exclusively based on routine data supplied by patient data management system, the ICUData, and to assess the predictive performance of this score using analysis of discrimination and calibration at an operative ICU. METHOD: SQL scripts (calculation programs) were developed to calculate the scores of 524 patients who stayed at the ICU between April 1st, 1999 and March 31st, 2000. The calculation programs considered unavailable data as 'not pathological'. The main outcome measure was survival status at ICU discharge. The discriminative power on mortality of this modified APACHE II score was checked with a receiver operating characteristic (ROC) curve. Calibration was tested using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: The 459 survivors had an average APACHE score of 17.8+/-5.3. The score of the 65 deceased patients averaged 22.7+/-4.6. The area under the ROC curve of 0.790 was significantly >0.5 (P<0.01) and had a 95% confidence interval (CI) of 0.712-0.825. The goodness-of-fit test showed a good calibration (H=4.89, P=0.70, dof 7, C=6.96, P=0.541, dof 8). CONCLUSION: A prediction model based on completely automatically calculated 'modified APACHE II scores' can be constructed using data collected with PDMS. However, due to differences in the patient collective and methods used, the results need validation and can only be partially compared to results from other studies.

APACHE↗

PubMed2002

Discriminative power on mortality of a modified Sequential Organ Failure Assessment score for complete automatic computation in an operative intensive care unit.

OBJECTIVE: To evaluate the discriminative power on mortality of a modified Sequential Organ Failure Assessment (SOFA) score and derived measures (maximum SOFA, total maximum SOFA, and delta SOFA) for complete automatic computation in an operative intensive care unit (ICU). DESIGN: Retrospective study. SETTING: Operative ICU of the Department of Anesthesiology and Intensive Care Medicine. PATIENTS: Patients admitted to the ICU from April 1, 1999, to March 31, 2000 (n = 524). Data from patients under the age of 18 yrs and patients who stayed <24 hrs were excluded. In the case of patient readmittance, only data from the patient's last stay was included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was survival status at ICU discharge. Based on Structured Query Language (SQL) scripts, a modified SOFA score for all patients who stayed in the ICU in 1 yr was calculated for each day in the ICU. Only routine data were used, which were supplied by the patient data management system. Score evaluation was modified in registering unavailable data as being not pathologic and in using a surrogate of the Glasgow Coma Scale. During the first 24 hrs, 459 survivors had an average SOFA score of 4.5 +/- 2.1, whereas the 65 deceased patients averaged 7.6 +/- 2.9 points. The area under the receiver operating characteristic (ROC) curve was 0.799 and significantly >0.5 (p <.01). A confidence interval (CI) of 95% covers the area (0.739-0.858). The maximum SOFA presented an area under the ROC of 0.922 (CI: 0.879-0.966), the total maximum SOFA of 0.921 (CI: 0.882-0.960), and the delta SOFA of 0.828 (CI: 0.763-0.893). CONCLUSION: Despite a number of differences between completely automated data sampling of SOFA score values and manual evaluation, the technique used in this study seems to be suitable for prognosis of the mortality rate during a patient's stay at an operative ICU.

Adult↗