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.