Evaluation of a modified APACHE II Scoring System in the Intensive Care Unit of a Tertiary Hospital in Nigeria

Abstract

Background: The use of the Acute Physiological And Chronic Health Evaluation (APACHE) II scoring system for critically ill intensive care unit (ICU) patients has not been evaluated in the ICU of the University College Hospital (UCH) Ibadan, due to lack of arterial blood gases. This study evaluated the predictive value of a modified APACHE II (MAPA II) in our patient population.
Patients and Methods: This prospective study was conducted over a 12 month period in the ICU of UCH, Ibadan. MAPA II format was designed from the APA II. The APA II score consists of 12 sets of acute physiological variables (A), age points (B) and chronic health points (C). Total APACHE II score of 71 was generated by adding A, B and C. (Appendix I). MAPA II score was generated by adding A, B and C but substituting PaO2 with SaO2 under A (Appendix 2). MAPA II scores were assigned to all the patients to calculate their observed and predicted risk of mortality which was compared with APA II.
Results: Total number of ICU admission was 282, of which 60 patients were studied. There were 39 (65%) survivors and 21 (35%) non-survivors, with MAPA II scores of 9.6 ± 7.1 (range 0-31) and 22.4 ± 11 (range 6-36) respectively. The demographic and other results are as shown on Tables I-IV. Interpretation & Conclusion: The MAPA II is a simple and objective tool for mortality prediction in ICU patients.

Key words: Modified APACHE II, mortality prediction, ICU evaluation