Validation of a modified apache II scoring system in predicting mortality in patients in the intensive care unit at the University Teaching Hospital,Lusaka-Zambia
Date
2017
Authors
Zyambo, Masuzyo
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
The major challenge of intensive care in Zambia is limited availability of resources.
With the increase in the number of intensive care units in the country, a tool to evaluate
and compare the standard of care across these units could be used to help direct
resources and provide quality assurance. Prognostic scoring systems may provide
such a tool. Currently UTH has no specific data collection or prognostic scoring systems
in place. Due to lack of facilities to directly measure oxygen partial pressure
and arterial pH in many of Zambia’s intensive care units, the APACHE II (Acute
Physiology and Chronic Health Evaluation II) scoring system, one of the most commonly
used prognostic critical care scoring systems, may not be feasible to undertake
countrywide. This study aimed at assessing how a modified APACHE scoring system
excluding blood gas analysis (i.e. no pH and PO2) compares to the full APACHE II
scoring system. This was a prospective cohort study conducted at the UTH intensive
care unit, where 51 patients were recruited with a mean age of 34 years. Clinical and
physiological variables were collected in the first 24 hours of admission, and a score
calculated for each scoring system. The primary outcome was mortality. Specificity
and sensitivity for each scoring system was determined and compared. The area under
receiver operating characteristic curve (AUROC) for the APACHE II was 0.78
(CI = 0.65–0.91, P = 0.01) and mAPACHE II 0.78 (CI = 0.66–0.91, P= 0.01). No
significant difference between the two scoring systems was found. There was no significant
difference between the areas under the two ROC curves for the standard
APACHE II scoring system and mAPACHE II scoring system. This study suggests
that the modified APACHE II may be an acceptable alternative to the full APACHE
II scoring system.
Description
THESIS M.MED
Keywords
Intensive care--APACHE II--Zambia , Intensive care--Mortality rate--Zambia