Modified APACHE scoring system provides reliable data

In an emergent setting, compilations of quantifiable data can help providers make decisions quickly and confidently about what next steps to take. Many scoring systems have been developed but have also proven unwieldy in real-life situations.

Dr. Spyridon Fortis, Clinical Assistant Professor in Pulmonary, Critical Care and Occupational Medicine, and a team of researchers in the Center for Access & Delivery Research & Evaluation (CADRE) at Iowa City VA Health Care System, simplified a critical illness severity scoring system and examined its performance to predict short-term mortality in critical ill patients. They published their findings in a recent issue of the Journal of Critical Care.

The new scoring system, mAPACHE, is a modification of APACHE III, and will allow health professionals to more easily obtain a patient’s estimated probability of death. All variables in APACHE III are considered in mAPACHE except tests such as the Glasgow Coma Scale (GCS), arterial blood gas, and urine output.

“The problem is that most of the critical illness severity scoring systems require data, like arterial blood gases or GCS, that may not be available or may be not accurately recorded outside the research environment,” Dr. Fortis said. “So, there is a need for simplified critical illness severity scoring systems.”

Dr. Fortis and CADRE’s modified scoring system provides efficient discrimination between ICU patients and 30-day mortality and can be used in ICUs worldwide with no need for specialized staff or software.

Even with mAPACHE only recently developed, Dr. Fortis and his team continue to improve their scoring system. The mAPACHE was tested against the records of 565,744 patients seen in 306 ICUs at 117 VA hospitals. Their results can be seen here.

 “Since mAPACHE was good but was still not as good as APACHE III, we wanted to create another severity scoring system with frequent available variables with performance similar to the APACHE III,” Dr. Fortis said. “When we have the new scoring system published, we can try to evaluate its performance outside the VA health system and compare it with APACHE III.”

Dr. Fortis’ colleagues on the study include Dr. Amy O’Shea, Dr. Rajeshwari Nair, Dr. Michihiko Goto, Dr. Peter Kaboli, Dr. Eli Perencevich, Dr. Heather Reisinger, Dr. Mary Vaughan-Sarrazin and Brice Beck.