Prognostic value of APACHE III scoring system in ICU.

Thesis Report.

ABSTRACT: Critically ill patients are provided the highest level of continuous care and treatment in an Intensive Care Unit (ICU). The high cost treatment in ICUs is clearly recognized and the ultimate benefit in terms of prolonging meaningful life is not well quantified. In addition, there is and intense demand for the limited ICU services. If the admission of a patient with a good chance of survival can be prioritised , then medical , financial and also human resources can be optimized in the delivery of health care services. Hence, clinical severity scoring system have been developed to help clinical decisions in prioritising patient management. The objective of this prospective study was to evaluate the prognostic value of the APACHE III scoring system of patients admitted to the ICU. Thirty patients admitted to a six bed multidisciplinary ICU at Tribuvan University Teaching Hospital (TUTH) were assessed using the APACHE III scoring system at admission. The patient's mean age was 42 years (range,2-82 Years) with equal numbers of male and female patients. The mean length of stay in the ICU was 7.2days (range,0-48 days). The mean age of patients who died was significantly higher than in the patients who survived, 57 years VS 32 years respectively (p=0.001).The mean APACHE III score of the patients who died was 29.7 while in surviving patients it was 23.0. Although there was no significant difference between the mean APACHE III score in these two groups, some variables used in APACHE III score( haematocrit and serum albumin) were significantly related to outcome. Furthermore, all the patients who survived had APACHE III score of less than 40, whereas, all the patients with scores above 40 and some with scores less than 40 also died. In conclusion, APACHE III is a good predictor of survival of patients admitted to the ICU and thus, may in channeling the limited resources of ICUs to appropriate patients.

Eng.