ABSTRACT
Meaningful comparison of patient outcomes requires an assessment of the severity of illness for the patients being compared. The more severe the underlying illness, the worse the expected outcome. We studied several severity of illness indicators derived from different methodologies in a medical intensive care unit. We compared the Acute Physiologic and Chronic Health Evaluation II, the accepted benchmark indicator for intensive care units, with one complex indicator, Computerized Severity Score, and three simpler indicators, Comorbidity, McCabe-Jackson, and American Society of Anesthesiologists. We found that all correlated well with a comorbidity index. We conclude that the Acute Physiologic and Chronic Health Evaluation II, the Computerized Severity Score, and the McCabe-Jackson scoring systems appear to be comparable predictors of comorbidity in a medical intensive care unit. Selection of a severity indicator will depend on the resources available and the intended uses.
Subject(s)
Comorbidity , Intensive Care Units/statistics & numerical data , Severity of Illness Index , Aged , Cross Infection/epidemiology , Evaluation Studies as Topic , Female , Humans , Length of Stay , Male , Middle Aged , New Jersey , Outcome Assessment, Health Care , Prospective StudiesABSTRACT
Infection control programs are primarily oriented toward chronicling the incidence of nosocomial infections (NI). Intervention programs oriented toward preventing infection would be facilitated by identifying patients at greatest risk of NI acquisition. We studied the number of comorbidities as a risk predictor for NIs in patients admitted to the medical intensive care unit (ICU) for three or more days. In 148 patients, we found by regression analysis that the number of comorbidities varied directly with the development of nosocomial infections, as well as with the appearance of new complications and length of ICU stay. Diagnosis-related groups did not adequately account for the variance in comorbidities observed.
