Admission Source to the Medical Intensive Care Unit Predicts Hospital Death Independent of APACHE II Score

Published in: JAMA, The Journal of the American Medical Association, v. 264, no. 18, Nov. 14, 1990, p. 2389-2394

Posted on RAND.org on December 31, 1989

by Jose J. Escarce, Mark A. Kelley

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This study was conducted to determine if the source of admission to the medical intensive care unit (MICU) is associated with hospital death independent of the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The authors calculated APACHE II scores and predicted risks of hospital death of 235 patients who were admitted to the MICU. The predicted death rate was the same as the actual rate for patients who were admitted directly from the emergency department (25% vs. 22%), but was less than the actual rate for patients who were transferred from hospital floors (38% vs. 55%), the medical intermediate care unit (323% vs. 59%), and other hospitals (21% vs. 36%). Logistic regression analysis confirmed an independent association between the MICU admission source and risk of death. The authors' findings suggest that APACHE II does not measure illness severity accurately in all patients who are admitted to intensive care units. If their results are generalizable, using APACHE II to compare intensive care outcomes among hospitals could lead to wrong conclusions about quality of care. Improving predictions of hospital death rates among patients who are in MICUs may require the inclusion of new types of information in the classification system.

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