APACHE II scoring was obtained retr...

APACHE II scoring was obtained retrospectively in succession patients admitted to the ICU of a university hospital for sum of two units consecutive years. During the first year the patients were treated at their attending physician (group 1); during the secondary year, by a trained critical care specialist in cooperation with the attending physician (group 2) There were 223 patients in cluster 1 and 216 in clump 2. The mean APACHE II scores were equivalent (group 1 190 [+ or -] 91 v collection 2, 18.3 [+ or -] 82 p = NS) ICU mortality was reduc at 52 percent (group 1, 278 percent mortality v collection 2, 13.4 percent mortality p<001) and overall hospital mortality was reduc 310 percent (group 1 355 percent v form into groups 2, 24.5 percent, p <001) No increased significance in ICU or hospital mortality reduction could be shown between subgroup of patients with APACHE II scores of 0 to 14 15 to 24 and >25 This retrospective analysis recommends that a full-time, trained critical care specialist may have made a significant impact forward the management of critically ill patients at our institution.

(Chest 1989; 96:127-29)

The late development of critical illness scores has provided a certain quantity of insight into patient-related factors that influence mortality in the ICU.[1-8] Attempts to application of mind factors related to the administrative formation of the ICU[1] and the prevalence of invasive techniques[7] have yielded be the effects that are difficult to interpret. The purport of on-site physicians in the ICU has been studied in a community hospital[7] and demonstrates that mortality is reduc from the presence of a physician in the ICU for 24 h by means of day. These authors[7] advise that a further decrease in mortality may fall out when the ICU is managed by dint of a critical care specialist. This retrospective subject of attention examines the ICU mortality and hospital mortality for patients according to their APACHE II[4] score in a teaching hospital and compares mortalities for patients with and without a full-time critical care specialist. The APACHE II score has been shown to be a advantageous predictor of mortality.[1]

Methods

The Plains Health Care middle is a 300-bed tertiary care facility that is affiliated with the University of Saskatchewan, Canada.

brace consecutive years were examined. During the first year, from July 1984 to June 1985 patients were managed according to their attending physician or surgeon (group 1 n = 223) During the secondary year, from July 1985 to June 1986 patients were managed from a critical care specialist (CCS) in consultation with the attending physician or surgeon (group 2 n = 216) For project of this study, a CC is defined as an individual who, in addition to board certification in a basic specialty, has luckily completed a further year of fellowship-level training in critical care.

During as well-as; not only-but also; not only-but; not alone-but study periods, there were surgical residents assigned to the ICU for three-month rotations, and night coverage was provided by the agency of residents on call for medicine and surgery During the first year, the resident would call the internist or surgeon upon call for back-up. During the inferior year, the primary CCS was onward duty every night and each second weekend. Alternate weekends were screened either by a board-certified anesthesiologist or by way of a trauma surgeon. During the next to the first year, work rounds and teaching sphericals were held daily. Protocols were lay opened and weekly lectures in critical care were instituted.

There was no significant change in staffing by dint of nurses or by ancillary personnel The referral patterns to the ICU were not changed between years. Entrance to the unit was determined by dint of the referring physician and not according to the CCS. All patients admitted to the ICU were included in the consideration except routine cardiac surgery patients, who were exclud because their management is routine and mortality reasonable in our institution. This is consistent with the observation of others.[4]

The mean duration of ICU stay for patients was the same for the pair years. At the last of the second study period, 439 patient charts representing all noncardiac surgery admissions for couple consecutive years were reviewed, and APACHE II scores onward admission to the ICU were determined. Each arrange was subdivided into three subgroup of approximately equal number representing APACHE II scores 0 to 14 15 to 25 and >25 Patients were followed up until death or discharge from the hospital. Percent mortalities were calculated for ICU and overall hospital days and for all APACHE II subgroups

Statistical Methods

The log-linear analysis was used to rule the individual and joint validity of APACHE II score and representation of physician/specialist (independent variables) in succession mortality (dependent variable). Deaths in the ICU or hospital were arranged with APACHE II score (three groupings) and emblem of physician (two groupings) into a multidimensional contingency table to which a log-linear type was fitted.[9]

Results

In Figure 1 the couple groups are compared with notice to the relationship between APACHE II score and ICU mortality. Similar data for the overall hospital mortality are shown in Figure 2 flows of the log-linear analysis point out that there was no significant difference (p>005) between the sum of two units groups with respect to the distribution of APACHE II score. Indeed the mean APACHE II scores were equivalent (group 1 190 [+ or -] 91 v assemblage 2, 18.3 [+ or -] 82) It can be seen in Figures 1 and 2 respectively, that the two ICU and overall hospital mortality increased with increasing APACHE II score. In as well-as; not only-but also; not only-but; not alone-but instances this relationship was significant (p<001) There was a significant difference between form into groupss 1 and 2 with revere to ICU mortality (p<0.01). The ICU mortality decreased from 278 percent to 134 percent or by means of about 50 percent.