+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

The effect of casemix adjustment on mortality as predicted by APACHE II



The effect of casemix adjustment on mortality as predicted by APACHE II



Intensive Care Medicine 22(5): 415-419



To describe the effect of casemix on mortality as predicted by APACHE II scoring. Retrospective analysis of an ICU database. All patients admitted to 19 ICU between 1 January 1992 and 31 May 1994 on whom data had been entered into a database. Excluded from the analysis were those readmitted to ICU, those aged under 16 years, those admitted after cardiac surgery or with burns, those for whom physiological data was incomplete and those for whom hospital outcome was unknown. Data on the remaining 6258 patients are reported. APACHE II scores were calculated from the worst values within 24 h of ICU admission. Hospital mortality was predicted with the published equation and coefficients. Mortality ratios (observed hospital deaths divided by predicted hospital deaths) were calculated for various groups. Mortality ratios varied widely by subgroup, and observed hospital deaths were greater than predicted, particularly for the following patient groups: those with predicted mortality of less than 70%, those with APACHE II scores in the range of 5-19, those older than 55 years, those with a Glasgow Coma Score of 15 or in the range 9-14, those not having emergency surgery, those with either 0 or 4 chronic health points and those in non-operative respiratory or neurological categories. The mortality ratio was markedly less than 1.0 only among non-operative cardiovascular patients. APACHE II did not accurately adjust for casemix in our data. Unless account is taken of differences in casemix, using mortality ratios to compare ICU is likely to be inaccurate and misleading.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 047617853

Download citation: RISBibTeXText

PMID: 8796392

DOI: 10.1007/bf01712157


Related references

Mortality predicted by APACHE II. The effect of changes in physiological values on predicted hospital mortality. Anaesthesia 52(5): 503-504, 1997

Mortality predicted by APACHE II. The effect of changes in physiological values and post-ICU hospital mortality. Anaesthesia 51(8): 719-723, 1996

A new casemix adjustment index for hospital mortality among patients with congestive heart failure. Medical Care 36(10): 1489-1499, 1998

Variability in predicted mortality assessed by apache ii and correlation with the autopsy findings. Laboratory Investigation 66(1): 101A, 1992

Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respiratory Care 40(10): 1042-1047, 1995

Hypoalbuminemic medical ICU admissions have increased acute renal failure and mortality not predicted by APACHE II score. Journal of the American Society of Nephrology 4(3): 327, 1993

An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit. Anaesthesia and Intensive Care 28(2): 171-177, 2000

Resource utilization and outcome in gravely ill intensive care unit patients with predicted in-hospital mortality rates of 95% or higher by APACHE III scores: the relationship with physician and family expectations. Mayo Clinic Proceedings 80(2): 166-173, 2005

Risk adjustment in measurements of predicted mortality after myocardial infarction. Tidsskrift for den Norske Laegeforening 136(5): 423-427, 2016

Prediction of mortality and quality of life in polytraumatized patients: APACHE II versus APACHE III. Revista Espanola de Anestesiologia Y Reanimacion 45(9): 361-366, 1998

Utility of the APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific ICU and ACU mortality. American Journal of Hospice & Palliative Care 28(5): 321-327, 2011

Mortality in an intensive care unit: predictive value of APACHE II severity score versus maximum APACHE. Revista Medica de Chile 121(1): 52-58, 1993

APACHE II, APACHE III, SOFA scoring systems, platelet counts and mortality in septic and nonseptic patients. Ulusal Travma Ve Acil Cerrahi Dergisi 11(1): 29-34, 2005

The impact of low-risk intensive care unit admissions on mortality probabilities by SAPS II, APACHE II and APACHE III. Anaesthesia 57(1): 21-26, 2002