PREDICTION OF THE RISK OF DEATH BY APACHE-II SCORING IN CRITICALLY ILL TRAUMA PATIENTS WITHOUT HEAD-INJURY

The ability of the Acute Physiology And Chronic Health Evaluation (APA CHE) II scoring system to predict outcome in 199 critically ill patien ts with trauma but without head injury was assessed prospectively over an 8-month period. Some 178 patients (89.4 per cent) underwent operat ion and 50 (25.1 per cent) died, 44 after operation and six without un dergoing surgery. The mean(s.d.) APACHE II score was 8.0 (5.2) for sur vivors and 14.5 (5.5) for non-survivors (P<0.001). In patients who und erwent surgery the mean(s.d.) scores were 7.7 (4.6) and 13.4 (5.5) (P< 0.001) and for those managed without operation 11.1 (7.2) and 14.7 (6. 3) (P=0.31) in survivors and non-survivors respectively. The predicted risk of death and observed mortality rate were 5.1 and 25.1 per cent respectively for the entire group, 5 and 25 per cent for patients unde rgoing surgery, and 7 and 29 per cent for those not operated on. Altho ugh the APACHE II system correctly identified all survivors (specifici ty 100 per cent), it failed to predict death in any patient (sensitivi ty 0 per cent). The results suggest that this objective prognostic sco ring system is not applicable to the patient with trauma who does not have concurrent head injury.