An analysis of excess mortality not predicted to occur by APACHE III in anAustralian level III intensive care unit

The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 da ta collected on 519 consecutive admissions to the Royal Adelaide Hospital I CU a standardized mortality ratio of 1.25 was calculated Of the 174 deaths only 95 had a prediction of death greater than 0.5 As part of a quality ass urance study we undertook a retrospective case note audit to try to identif y factors that were associated with the low mortality prediction (<0.5) in hospital deaths. Firstly we analysed the patient population that died to determine the facto rs that were different between patients who had a mortality prediction of g reater than 0.5 versus those who had a mortality prediction of less than 0. 5 Next we analysed the patient population with a mortality prediction of le ss than 0.5 and compared actual survivors with patients who died in hospita l. Amongst low mortality prediction patients admitted to the Royal Adelaide Ho spital ICU we identified age, a history of acute myocardial infarction, pre sentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admis sion as being associated with in-hospital mortality We also documented that late hospital deaths on the weird after ICU discharge occurred more freque ntly with low predicted hospital mortality ICU patients, Factors other than the APACHE III score may be associated with hospital deaths of ICU patient s.