Acute Physiology and Chronic Health Evaluation (APACHE) III Score compared to Trauma-Injury Severity Score (TRISS) in Predicting Mortality of Trauma Patients.

INTRODUCTION: More than 50 scoring systems have been published for classification of trauma patients in the field, emergency room, and intensive care settings, so far. The present study aimed to compare the ability of trauma injury severity score (TRISS) and acute physiology and chronic health evaluation (APACHE) III in predicting mortality of intensive care unit (ICU) admitted trauma patients. METHODS: This prospective cross-sectional study included ICU admitted multiple trauma patients of Imam Hossein and Hafte-Tir Hospitals, Tehran, Iran, during 2011 and 2012. Demographic data, vital signs, mechanism of injury and required variables for calculating APACHE III score and TRISS were recorded. The accuracy of the two models in predicting mortality of trauma patients was compared using area under the ROC curve. RESULTS: 152 multiple trauma patients with mean age of 37.09 ± 14.60 years were studied (78.94% male). 48 (31.57%) cases died. For both APACHE III and TRISS, predicted death rates significantly correlated with observed death rates (p < 0.0001). The mean age of dead patients was 37.21 ± 14.07 years compared to 37.03±14.96 years for those who survived (p = 0.4). The area under ROC curve was 0.806 (95% CI: 0.663-0.908) for TRISS and 0.797 (95% CI: 0.652-0.901) for APACHE III (p = 0.2). CONCLUSION: Based on the results of this study, both TRISS and APACHE models have the same accuracy in predicting mortality of ICU admitted trauma patients. Therefore, it seems that TRISS model would be more applicable in this regard because of its easier calculation, consideration of trauma characteristics, and independency of patient care quality.

Correlation between capillary and arterial blood gas parameters in an ED.

BACKGROUND AND AIMS: Sampling from arteries for the analysis of blood gases is a common procedure in emergency departments (ED). The procedure is painful for the patients and causes concern for the medical personnel due to possible complications, such as hematoma, infection, ischemia, and formation of fistula or aneurism. The present study compared the results of capillary and arterial blood gases analyses (CBG and ABG) to emphasizing a less aggressive technique with the fewest complications for this procedure. MATERIALS AND METHODS: In the comparative/analytical study, the results of ABG and CBG for 187 patients referring to the ED of a teaching hospital were compared using SPSS 18 statistical software (SPSS, Chicago, IL) in relation to the mean partial pressure of oxygen (Po(2)), partial pressure of carbon dioxide (Pco(2)), base excess (BE), bicarbonate (HCO(3)), serum acidity (pH), and saturation of hemoglobin oxygen (SaO(2)). RESULTS: Saturation of hemoglobin oxygen, HCO(3), pH, Pco(2), Po(2), and BE exhibited significant statistical correlation between ABG and CBG (P = .001). The average correlations between capillary and arterial samples were 0.78 for pH, 0.73 for Pco(2), 0.71 for BE, 0.90 for HCO(3), 0.77 for Po(2), and 0.52 for SaO(2). Comparison of the parameters means did not exhibit significant differences between arterial and capillary samples except for Po(2) and SaO(2) (P > .05). CONCLUSION: There appear to be strong correlation between samples collected from the finger tip capillaries with the arterial blood samples in relation to the analysis of blood gas.

Evaluation of the Acute Physiology and Chronic Health Evaluation III in predicting the prognosis of patients admitted to Emergency Department, in need of intensive care unit.

INTRODUCTION: Many of critically ill patients receive medical care for prolonged periods in emergency department (ED). This study is the evaluation of efficiency of Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in predicting mortality rate in these patients. METHODS: This study was conducted between 2008 and 2009 in Tehran, Iran. One hundred subjects were enrolled in the study. Cases were chosen from patients in need of intensive care unit (ICU) bed who were kept in the ED. The APACHE III scores and predicted and observed mortality rates were calculated using the information from patients' files, interviews with the patients' families, and performing required physical examinations and laboratory tests. RESULTS: The age of the patients and the ED length of stay were 66.07 (±19.92) years and 5.11 (±3.79) days, respectively. The mean (±SD) of APACHE III score of the patients was 58.89 (±18.24). The predicted mortality rate was calculated to be 32.73%, whereas the observed mortality rate was 55%. The mean (±SD) of APACHE III score of survivors and nonsurvivors was 48.63 (±16.35) and 67.63 (±14.84), respectively (P < .001). Furthermore, the ED length of stay was 3.20 (±1.34) and 6.57 (±4.4) days in survivors vs nonsurvivors, respectively (P < .001). CONCLUSION: The APACHE III score and ED lengths of stay were higher in this study compared with other studies. This could be ascribed to more critical patients presenting to the study center and also limited ICU bed availability. This study was indicative of applicability of APACHE III scoring system in evaluating the quality of care and prognosis of ED patients in need of ICU.