Based on the rationale that hemodynamic, oxygen transport, and perfusion derangements describe physiologically important abnormalities in critically ill patients, we devised a Critical Care Scoring System (CCSS). The database includes a retrospective analysis of 318 patients managed with pulmonary artery catheters during 1986 to 1988. For comparison, Acute Physiology and Chronic Health Evaluation (APACHE II) score was computed for these patients. CCSS includes a total of 17 variables with a weighted score of 71.
The mortality rates for increases by 5 points were observed and were statistically significant (p < .0001). The same was not true for APACHE II. Although neither of the scores could predict ICU days, both reflected the number of life-threatening complications.
Serial CCSS that was computed at 24 ± 4 h (CCSS-C) provided documentation for improvement in patient condition secondary to therapeutic interventions. Statistically improved mortality prediction was observed with CCSS-C. Since 70 (45.7%) of 153 patients died with an APACHE II score <14, it appears that this score is deficient in a specific group of patients, i.e., those requiring invasive monitoring. For patients with circulatory or respiratory failure, CCSS may offer a better tool to predict mortality and evaluate therapy.
From the Critical Care Center, Mount Carmel Mercy Hospital, Detroit, MI.