Physician risk assessment and APACHE scores in cardiac care units

Background: The need to correct outcome data for case mix is well recognize d, but risk assessment for coronary care unit (CCU) patients remains proble matic. Hypothesis: This study determined the feasibility of using physician s' opinions to predict mortality for CCU patients and compared their result s to Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Methods. A prospective observational study was performed on consecutive pat ients admitted to a university-affiliate Veterans Affairs Medical Center CC U over a 2-month period. Physician assessment of likely mortality during ho spitalization, obtained using an MD Prognosis Score ranging from 1 (best) t o 7 (worst), was compared with APACHE II scores. Results: MD Prognosis Scores were obtained on 122 of the 237 eligible patie nts (51% response rate) and averaged 2.3 +/- 1.4 (mean +/- standard deviati on). APACHE II scores on these patients averaged 9.9 +/- 4.8 (range 2-29) w ith very poor correlation between the two methods (r = 0.3). Of the four pa tients who died, three had MD prognosis scores of 7. None of the survivors had scores of 7 and only three had scores of 6. APACHE II did not predict a high likelihood that any of the patients would die (none with > 90% likeli hood of mortality). Conclusions: APACHE scores are inadequate for cardiac patients. Although ph ysicians can identify CCU patients most likely to die, reliance on physicia n scoring systems is limited by difficulties in obtaining their opinion. A new method of risk assessment for acutely ill cardiac patients is needed if CCU outcomes an to be compared across institutions.