Comparison of illness severity scoring systems for mortality prediction in Neurointensive Care Unit in India

Abstract

Background: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality rate was 19.8%, and the scores of all the SSs correlated significantly with GOS (P < 0.001). All the scores were significantly different between survivors and non-survivors. The accuracy of all the SSs to predict survival and non-survival was more than 80%. The highest accuracy rate was seen for GCS and SAPS (84.3% and 83.8%, respectively). Conclusions: The SSs used in this study had good predictive power, and they had good discriminative ability between survivors and non-survivors. GCS and SAPS have the highest predictive ability, GCS having added advantage of being simple and practical.

Keywords

Acute Physiology and Chronic Health Evaluation II and IV - Glasgow Coma Scale - mortality prediction model - Neurointensive Care Unit - scoring system - Simplified Acute Physiology Score

• REFERENCES

• 1 Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the Intensive Care Unit. Crit Care Med 2011; 39: 163-9
• 2 Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA. Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 1984; 61: 241-53
• 3 Fielding K, Rowley G. Reliability of assessments by skilled observers using the Glasgow Coma Scale. Aust J Adv Nurs 1990; 7: 13-7
• 4 Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 2004; 56: 1084-9
• 5 Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult Intensive Care Units. Crit Care Clin 2007; 23: 639-58
• 6 Cho DY, Wang YC. Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome. Intensive Care Med 1997; 23: 77-84
• 7 Ting HW, Chen MS, Hsieh YC, Chan CL. Good mortality prediction by Glasgow Coma Scale for neurosurgical patients. J Chin Med Assoc 2010; 73: 139-43
• 8 Nejmi H, Rebahi H, Ejlaidi A, Abouelhassan T, Samkaoui MA. The ability of two scoring systems to predict in-hospital mortality of patients with moderate and severe traumatic brain injuries in a Moroccan Intensive Care Unit. Indian J Crit Care Med 2014; 18: 369-75
• 9 Zali AR, Seddighi AS, Seddighi A, Ashrafi F. Comparison of the acute physiology and chronic health evaluation score (APACHE) II with GCS in predicting hospital mortality of neurosurgical Intensive Care Unit patients. Glob J Health Sci 2012; 4: 179-84
• 10 Cuthbertson BH, Rajalingam Y, Harrison S, McKirdy F. The outcome of haematological malignancy in Scottish Intensive Care Units. J Intensive Care Soc 2008; 9: 135-40
• 11 Brandner S, Kellermann I, Hore N, Bozhkov Y, Buchfelder M. Clinical Course Score (CCS): A new clinical score to evaluate efficacy of neurotrauma treatment in traumatic brain injury and subarachnoid hemorrhage. J Neurosurg Anesthesiol 2015; 27: 26-30
• 12 Handschu R, Haslbeck M, Hartmann A, Fellgiebel A, Kolominsky-Rabas P, Schneider D. et al. Mortality prediction in critical care for acute stroke: Severity of illness-score or coma-scale?. J Neurol 2005; 252: 1249-54