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Titolo:
Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality
Autore:
Grmec, S; Gasparovic, V;
Indirizzi:
Maribor Teaching Hosp, Emergency Med Serv, EMS PHU, MIS-2000 Maribor, Slovenia Maribor Teaching Hosp Maribor Slovenia MIS-2000 S-2000 Maribor, Slovenia Univ Dept Internal Med Emergency & Intens Care Me, Zagreb, Croatia Univ Dept Internal Med Emergency & Intens Care Me Zagreb Croatia roatia
Titolo Testata:
CRITICAL CARE
fascicolo: 1, volume: 5, anno: 2001,
pagine: 19 - 23
SICI:
1466-609X(2001)5:1<19:COAIMA>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
CLASSIFICATION-SYSTEM; ACUTE PHYSIOLOGY; INTENSIVE-CARE; CARDIAC-ARREST; HEAD-INJURY; CONSCIOUSNESS; PROGNOSIS; LEVEL; SCORE;
Keywords:
Acute Physiology and Chronic Health Evaluation II; Glasgow Coma Scale; Mainz Emergency Evaluation system; nontraumatic coma; prediction of mortality;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Grmec, S Maribor Teaching Hosp, Emergency Med Serv, EMS PHU, Ljubljanska 5, MIS-2000 Maribor, Slovenia Maribor Teaching Hosp Ljubljanska 5 Maribor Slovenia MIS-2000 ia
Citazione:
S. Grmec e V. Gasparovic, "Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality", CRIT CARE, 5(1), 2001, pp. 19-23

Abstract

Introduction: There are numerous prehosital descriptive scoring systems, and it is uncertain whether they are efficient in assessing of the severity of illness and whether they have a prognostic role in the estimation of theillness outcome (in comparison with that of the prognostic scoring system Acute Physiology and Chronic Health Evaluation [APACHE] II). The purpose ofthe present study was to assess the value of the various scoring systems in predicting outcome in nontraumatic coma patients and to evaluate the importance of mental status measurement in relation to outcome. Patients and methods: In a prehospital setting, postintervention values ofthe Mainz Emergency Evaluation System (MEES) and Glasgow Coma Scale (GCS) were measured for each patient. The APACHE II score was recorded on the dayof admission to the hospital. This study was undertaken over a 2-year period (from January 1996 to October 1998), and included 286 consecutive patients (168 men, 118 women) who were hospitalized for nontraumatic coma. Patients younger than 16 years were not included. Their age varied from 16 to 87 years, with mean +/- standard deviation of 51.8 +/- 16.9 years. Sensitivity, specificity and correct prediction of outcome were measured using the chi(2) method, with four severity scores. The best cutoff point in each scoring system was determined using the Youden index. The difference in Youden index was calculated using the Z score. For each score, the receiver operating characteristic (ROC) curve was obtained. The difference in ROC was calculated using the Z score. P < 0.05 was considered statistically significant. Results: For prediction of mortality, the best cutoff points were 19 for APACHE II, 18 for MEES and 5 for GCS. The best cutoffs for the Youden index were 0.63 for APACHE II, 0.61 for MEES and 0.65 for GCS. The correct prediction of outcome was achieved in 79.9% for APACHE II, 78.3% for MEES and 81.9% for GCS. The area under the ROC curve (mean +/- standard error) was 0.86+/- 0.02 for APACHE II, 0.84 +/- 0.06 for MEES and 0.88 +/- 0.03 for GCS. There were no statistically significant differences among APACHE II, MEES and GCS scores in terms of correct prediction of outcome, Youden index or area under ROC curve. Conclusions: APACHE II is not much better than prehospital descriptive scoring systems (MEES and GCS). APACHE II and MEES should not replace GCS in assessment of illness severity or in prediction of mortality in nontraumaticcoma. For the assessment of mortality, the GCS score provides the best indicator for these patients (simplicity, less time-consuming and effective inan emergency situation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/04/20 alle ore 13:21:59