Lesly A Dossett1, Leigh Anne Redhage, Robert G Sawyer, Addison K May. 1. Division of Trauma & Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 404 Medical Arts Building, Nashville, TN 37212, USA. lesly.dossett@vanderbilt.edu
Abstract
BACKGROUND: Quality and benchmarking initiatives highlight the need for accurate stratified risk adjustment. The stratification of trauma patients has relied on scores specific to trauma populations. While the Acute Physiologic and Chronic Health Evaluation (APACHE) II score has been considered "invalid" in the trauma population, we hypothesized that APAHCE II would more accurately predict outcomes in critically injured patients in whom commonly used trauma scores have inherent limitations. METHODS: A prospective cohort of critically injured patients was enrolled. Severity scores and their sub-components were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Logistic regression estimated the odds of death associated with incremental changes in severity scores and their subcomponents. RESULTS: 1019 patients were available for analysis. APACHE II was the best predictor of mortality (AUROC 0.77 versus AUROC 0.54 for ISS and 0.64 for TRISS). A unit increase in APACHE II was associated with an OR of death of 1.18 (95% CI 1.14-1.22). The components of APACHE II that contributed the most to its accuracy included temperature, serum creatinine and the Glasgow Coma Scale (GCS). CONCLUSION: Critically injured patients have physiologic derangements not accurately accounted for by commonly used trauma scores. In this subset a more general ICU scoring system is useful for risk adjustment for research, administrative and quality improvement purposes.
BACKGROUND: Quality and benchmarking initiatives highlight the need for accurate stratified risk adjustment. The stratification of traumapatients has relied on scores specific to trauma populations. While the Acute Physiologic and Chronic Health Evaluation (APACHE) II score has been considered "invalid" in the trauma population, we hypothesized that APAHCE II would more accurately predict outcomes in critically injured patients in whom commonly used trauma scores have inherent limitations. METHODS: A prospective cohort of critically injured patients was enrolled. Severity scores and their sub-components were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Logistic regression estimated the odds of death associated with incremental changes in severity scores and their subcomponents. RESULTS: 1019 patients were available for analysis. APACHE II was the best predictor of mortality (AUROC 0.77 versus AUROC 0.54 for ISS and 0.64 for TRISS). A unit increase in APACHE II was associated with an OR of death of 1.18 (95% CI 1.14-1.22). The components of APACHE II that contributed the most to its accuracy included temperature, serum creatinine and the Glasgow Coma Scale (GCS). CONCLUSION: Critically injured patients have physiologic derangements not accurately accounted for by commonly used trauma scores. In this subset a more general ICU scoring system is useful for risk adjustment for research, administrative and quality improvement purposes.
Authors: Javier González-Robledo; Félix Martín-González; Mercedes Sánchez-Barba; Fernando Sánchez-Hernández; María N Moreno-García Journal: J Med Syst Date: 2017-07-28 Impact factor: 4.460
Authors: Tjasa Hranjec; Brian R Swenson; Lesly A Dossett; Rosemarie Metzger; Tanya R Flohr; Kimberley A Popovsky; Hugo J Bonatti; Addison K May; Robert G Sawyer Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Christopher A Guidry; Brian R Swenson; Stephen W Davies; Lesly A Dossett; Kimberley A Popovsky; Hugo Bonatti; Heather L Evans; Rosemarie Metzger; Traci L Hedrick; Carlos A Tache-Léon; Tjasa Hranjec; Irshad H Chaudry; Timothy L Pruett; Addison K May; Robert G Sawyer Journal: Crit Care Med Date: 2014-05 Impact factor: 7.598