Optimization of Data Collection during Public Health Emergencies—Experience with APACHE II ScoreFunding This work was partially funded by a contract from the US Food and Drug Administration.
16 January 2018
16 January 2019
10 April 2019 (online)
Background Capturing accurate clinical data in real time is a challenge during public health emergencies. The United States Critical Illness and Injury Trials Group-Program for Emergency Preparedness is committed to improving these preparedness efforts.
Objectives We aimed to create an electronic Acute Physiology and Chronic Health Evaluation (APACHE) II data collection instrument that (1) leverages Research Electronic Data Capture (REDCap) automated calculations and logic, (2) may be shared across sites, (3) overcomes limitations in existing APACHE II instruments in the REDCap library, and (4) suggests changes to be made to data collection instruments during emergencies.
Methods The APACHE II instrument was implemented using REDCap. Data fields were divided into four sections: age, Acute Physiology, Glasgow Coma Scale, and chronic health status. Usability testing was followed by two preliminary evaluations: a comparison to existing APACHE II instruments and a simulated emergency exercise.
Results The final instrument consisted of 34 data fields. It produced an accurate APACHE II score and was faster to complete than two previous implementations (average of 97.5 seconds vs. 323.5 and 183.5 seconds). During the simulated emergency exercise, the instrument was used at 10 sites to create 34 patient records; median time to complete the instrument was 150.5 seconds.
Conclusion This project demonstrated feasibility of improving the accuracy and efficiency of a data collection instrument. Future efforts should focus on expanding these methods to develop other scoring tools for use during emergencies and additional testing to ensure it is ready for use during a real emergency.
Keywordstesting and evaluation - data quality - emergency and disaster care - intensive and critical care - public health
Protection of Human and Animal Subjects
This study did not involve any human/animal subjects.
- 1 Ortiz JR, Rudd KE, Clark DV, Jacob ST, West TE. Clinical research during a public health emergency. Crit Care Med 2013; 41 (05) 1345-1352
- 2 Yu S, Leung S, Heo M. , et al. Comparison of risk prediction scoring systems for ward patients: a retrospective nested case-control study. Crit Care 2014; 18 (03) R132
- 3 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 4 Blum JM, Morris PE, Martin GS. , et al. United States Critical Illness and Injury Trials Group. Chest 2013; 143 (03) 808-813
- 5 Murphy DJ, Rubinson L, Blum J. , et al. Development of a core clinical dataset to characterize serious illness, injuries, and resource requirements for acute medical responses to public health emergencies. Crit Care Med 2015; 43 (11) 2403-2408
- 6 Pang X, Kozlowski N, Wu S. , et al. Construction and management of ARDS/sepsis registry with REDCap. J Thorac Dis 2014; 6 (09) 1293-1299
- 7 Gallagher SA, Smith AB, Matthews JE. , et al. Roadmap for the development of the University of North Carolina at Chapel Hill Genitourinary OncoLogy Database–UNC GOLD. Urol Oncol 2014; 32 (01) 32.e1-32.e9
- 8 da Silva KR, Costa R, Crevelari ES. , et al. Glocal clinical registries: pacemaker registry design and implementation for global and local integration–methodology and case study. PLoS One 2013; 8 (07) e71090
- 9 Morinville VD, Lowe ME, Ahuja M. , et al. Design and implementation of INSPPIRE. J Pediatr Gastroenterol Nutr 2014; 59 (03) 360-364
- 10 Obeid JS, McGraw CA, Minor BL. , et al. Procurement of shared data instruments for Research Electronic Data Capture (REDCap). J Biomed Inform 2013; 46 (02) 259-265
- 11 Lurie N, Manolio T, Patterson AP, Collins F, Frieden T. Research as a part of public health emergency response. N Engl J Med 2013; 368 (13) 1251-1255
- 12 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13 (10) 818-829
- 13 Headley J, Theriault R, Smith TL. Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit. Cancer 1992; 70 (02) 497-503
- 14 Li H-Y, Li S-J, Yang N, Hu W-L. Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit. J Clin Neurosci 2014; 21 (08) 1409-1412
- 15 Moon BH, Park SK, Jang DK, Jang KS, Kim JT, Han YM. Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients. J Clin Neurosci 2015; 22 (01) 111-115
- 16 Bellary S, Krishnankutty B, Latha MS. Basics of case report form designing in clinical research. Perspect Clin Res 2014; 5 (04) 159-166
- 17 Crawford TC, Grimm JC, Magruder JT. , et al. A curious case of acute respiratory distress syndrome. J Surg case reports 2015;2015(11). Doi: 10.1093/jscr/rjv140
- 18 Papadopoulos N, Martens S, Keller H, El-Sayed Ahmad A, Moritz A, Zierer A. Challenging rescue of a 4 years old boy with H1N1 infection by extracorporeal membrane oxygenator: a case report. World J Clin cases 2014; 2 (10) 578-580
- 19 Masaki K, Ishii M, Anraku M. , et al. Fatal fulminant pneumonia caused by methicillin-sensitive staphylococcus aureus negative for major high-virulence factors following influenza b virus infection. Am J Case Rep 2015; 16: 454-458
- 20 Fadila MF, Wool KJ. Rhabdomyolysis secondary to influenza a infection: a case report and review of the literature. N Am J Med Sci 2015; 7 (03) 122-1224
- 21 Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014; 13 (08) 844-854