Análisis de la mortalidad en la unidad de cuidados intensivos del Hospital Central de Mendoza, Argentina
Objective: To analyze the mortality in the Intensive Care Unit (ICU) of Mendoza Central Hospital and evaluate the predictive value of the APACHE II score (Acute Physiology and Chronic Health Evaluation). Methodology: In a retrospective observational study the clinical records from the patients a...
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| Publicado en: | Revista Médica Universitaria |
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| Autores principales: | , , |
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| Acceso en línea: | https://bdigital.uncu.edu.ar/fichas.php?idobjeto=3439 |
| Sumario: | Objective: To analyze the mortality in the Intensive Care Unit (ICU) of Mendoza
Central Hospital and evaluate the predictive value of the APACHE II score
(Acute Physiology and Chronic Health Evaluation).
Methodology: In a retrospective observational study the clinical records from
the patients admitted into the Mendoza Central Hospital ICU, between
01/Nov/06 to 31/Mar/08, were reviewed. Sex and age distribution, average
length of stay, major admissions causes and APACHE II score within 24 hours
of admission were calculated. Observed and expected mortality and their ratio
were analyzed.
Results: 904 patients were included, 61.82% males and 38.18% females, with
an average age of 46 years (±19.36). Average length of stay for patients
admitted in the ICU was 8.5 days. The major cause of admission was traumatic
brain injury at 27.7% (86% associated with severe polytrauma). Global mortality
was 41.48% vs. an expected 24.08%, with a mortality ratio of 1.72 (p<0,0001).
Conclusions: The studied ICU presented high mortality rates due specific
characteristics of the attended population. The observed mortality was 72%
higher than that predicted by the APACHE II score, indicating that this model
has a low predictive power in our Hospital. The difference between the two
mortality rates could be partially explained by a high prevalence of diseases
under-predicted by this model, such as multiple trauma and neurocritically ill
patients. In these patients, APACHE II score failed to predict mortality
accurately. We suggest that a logistical regression study be performed to
determine a correction factor and/or add points to the APACHE II score
according the diagnosis at admittance. We propose to evaluate the use of third
generation models to predict mortality, such as APACHE III, MPM II y SAPS II.
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