THE USE OF INTENSIVE-CARE INFORMATION-SYSTEMS ALTERS OUTCOME PREDICTION

Objective: To study the effect of using an Intensive Care In formation System (ICIS) on severity scores and prognostic indices: Acute Physio logy and Chronic Health Evaluation II (APACHE II), Simplified Acute Ph ysiology Score II (SAPS II), and Mortality Probability Models II (MPM II). Design: Prospective pilot study. Setting: A 20-bed medical-surgic al intensive care unit (ICU) in a teaching hospital. Patients: 50 cons ecutive adult patients admitted to the ICU on a bed equipped with an I CIS. Interventions: None. Measurements and results: In each patient al l the physiologic variables, as required by the severity scores, were both manually charted and recorded by ICIS. ICIS registration resulted in the extraction of more abnormal values for all physiologic variabl es (except temperature): p < 0.05. Higher severity scores and mortalit y prediction were achieved by using ICIS charting: predicted mortality increased by 15 % for APACHE II compared to manual charting, 25 % for SAPS II, and 24 % for MPM0. ICIS charting resulted in higher severity scores and mortality prediction for 29 of the 50 patients using APACH E II with a mean increase in mortality prediction in this subgroup of 27 %. In the case of SAPS II, ICIS charting resulted in higher scores in 23 of the 50 patients and in the case of MPM0 in 13 patients, the m ean increase in mortality in these subgroups being 64 and 148 %, respe ctively. Conclusions: The use of ICIS charting to acquire the most abn ormal physiologic values for severity scores and the derived prognosti c indices results in a higher mortality prediction. Comparison of grou ps of patients and/or ICUs based on severity scores is impossible with out standardization of data collection. The mortality prediction model s have to be revalidated for the use of ICIS charting. While awaiting this, we suggest that every patient record in local regional, national , or international ICU databases should be marked as being recorded by manual or by ICIS charting.