Patient outcome and intensive care resource allocation using APACHE II.

Abstract

A prospective study of seventy consecutive admissions to the Medical Intensive Care Unit (MICU) of a local hospital over a five-month period was conducted with the aim of developing objective criteria for critical care resource allocation. Patients gaining admission were subjected to APACHE II scoring and their progress followed till they recovered from their illness or perished. The mean APACHE II score of patients who recovered from their illness or perished were 12.96 and 28.52 respectively (p < 0.001). 91.5% of all patients who recovered had an APACHE II score of below 21 whereas 82.6% of those who died had an APACHE II score of more than 23. Males generally had poorer outcome than females [47% mortality vs 8% (p < 0.001)] although their mean ages were comparable [47.6 years vs 46.6 years respectively (p = 0.85)]. The mean APACHE II scores of male and female patients were significantly different [male = 20.6 vs female = 13.6 (p < 0.005)] and this partly accounted for the poorer outcome of males. The APACHE II score has considerable predictive value on the final outcome of patients admitted to the MICU. When ICU beds are short, the allocation of such beds may be made with consideration of the APACHE II Score which identifies the patient who is most likely to benefit from ICU care.