A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients

Risk adjustment and mortality prediction in studies of critical care are usually performed using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), which emphasize physiological derangement. Common risk adjustment systems used in administrative datasets,...

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Bibliographic Details
Published in:BMC health services research 2009-07, Vol.9 (1), p.129-129, Article 129
Main Authors: Quach, Susan, Hennessy, Deirdre A, Faris, Peter, Fong, Andrew, Quan, Hude, Doig, Christopher
Format: Article
Language:English
Subjects:
Acquisitions & mergers
Aged
Alberta
Algorithms
APACHE
Automation
Codes
Critical care
Critical Illness - mortality
Data collection
Female
Health sciences
Health services
HIV
Hospital Mortality
Hospitals
Human immunodeficiency virus
Humans
Illnesses
Information systems
Intensive care
Intensive Care Units
Laboratories
Male
Middle Aged
Morbidity
Mortality
Patients
Physiology
Population
Risk Adjustment - methods
Studies
Variables
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Summary:Risk adjustment and mortality prediction in studies of critical care are usually performed using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), which emphasize physiological derangement. Common risk adjustment systems used in administrative datasets, like the Charlson index, are entirely based on the presence of co-morbid illnesses. The purpose of this study was to compare the discriminative ability of the Charlson index to the APACHE II in predicting hospital mortality in adult multisystem ICU patients. This was a population-based cohort design. The study sample consisted of adult (>17 years of age) residents of the Calgary Health Region admitted to a multisystem ICU between April 2002 and March 2004. Clinical data were collected prospectively and linked to hospital outcome data. Multiple regression analyses were used to compare the performance of APACHE II and the Charlson index. The Charlson index was a poor predictor of mortality (C = 0.626). There was minimal difference between a baseline model containing age, sex and acute physiology score (C = 0.74) and models containing either chronic health points (C = 0.76) or Charlson index variations (C = 0.75, 0.76, 0.77). No important improvement in prediction occurred when the Charlson index was added to the full APACHE II model (C = 0.808 to C = 0.813). The Charlson index does not perform as well as the APACHE II in predicting hospital mortality in ICU patients. However, when acuity of illness scores are unavailable or are not recorded in a standard way, the Charlson index might be considered as an alternative method of risk adjustment and therefore facilitate comparisons between intensive care units.
ISSN:1472-6963
1472-6963
DOI:10.1186/1472-6963-9-129