A COMPARISON OF SEVERITY OF ILLNESS SCORING SYSTEMS FOR CRITICALLY ILL OBSTETRIC PATIENTS

Study objective: To evaluate the predictive ability of three scoring s ystems, acute physiology and chronic health evaluation (APACHE II), si mplified acute physiology score (SAPS II), and mortality probability m odels (MPM II) in critically ill obstetric patients compared to a cont rol group of nonobstetric female patients of similar age group (range, 17 to 41 years). Design: A retrospective medical chart review of obst etric and nonobstetric female patients between 17 and 41 years of age, Setting: Two university hospitals, Patients: Ninety-three obstetric p atients and 96 nonobstetric female patients were identified from 12,74 0 consecutive ICU admissions. Results: The actual mortality of the obs tetric and the nonobstetric group was 10.8% (95% confidence interval [ CI], 5.3 to 19.0%) and 12.0% (95% CI, 6.6 to 21.0%), respectively, The observed mortality was not statistically different from the mortality predicted by APACHE II, SAPS II, and MPM;I II (14.146, 7.8%, and 9.1% for the obstetric group and 10.9%, 9.0%, and 9.9% for the nonobstetri c group). Predictive accuracy was assessed by the c-index, which is eq uivalent to the area under the receiver operator characteristic (ROC) curve. There mere no significant differences in the c-index: for APACH E II, SAPS II, and MPM II within or between the obstetric group ([mean +/-SE], 0.93+/-0.02, 0.90+/-0.04, and 0.91+/-0.04, respectively) and t he nonobstetric group (0.91+/-0.02, 0,95+/-0.03, and 0.96+/-0.02, resp ectively). Conclusions: We conclude that APACHE II, SAPS II, and MPM I I assess the ICU outcome of critically il obstetric patients as accura tely as nonobstetric critically ill female patients of similar age gro up.