Comparison of Simplified Acute Physiology Score-III and Mortality Probability Model-III in Trauma Patients

Document Type : Original Article (s)

Authors

1 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Intensive care unit (ICU) is among the most important hospital wards. Variety of scoring systems for evaluation of patients' status and prediction of hospitalization outcomes in ICU has been raised that each has strong and weak points; assessment of these characteristics tends to promote new scoring systems. The current study compared scoring systems of Mortality Probability Model-III (MPM-III) and Simplified Acute Physiology Score-III (SAPS-III) in trauma patients in ICU.Methods: This randomized cross-sectional study was conducted on 200 patients admitted in ICU because of trauma in years 2016-17. Patients' information including demographics, mean of systolic, diastolic, and arterial blood pressure, pulse, respiratory rate, temperature, Glasgow coma scale (GCS), arterial gas analysis, white blood cell (WBC) counts, hematocrit, bilirubin, creatinine, type of admission, and presence of underlying diseases were extracted from records; MPM-III and SAPS-III were measured for these patients and compared.Findings: MPM-III scoring system had discrimination of 0.935 [95% confidence interval (95%CI): 0.89-0.97; P < 0.001) in cut-off point of 0.13, and its sensitivity and specificity was 87% and 84%, respectively. For SAPS-III system, in cut-off point of 0.13, the discrimination was 0.77 (95%CI: 0.69-0.85; P < 0.001), with the sensitivity of 80% and specificity of 68%. Based on both MPM-III and SAPS-III systems, mortality was in correlation with duration of ICU admission (P = 0.001 for both systems) and duration of intubation (P < 0.001 for both systems), while only for SAPS-III, total duration of hospitalization was in correlation with mortality (P < 0.001).Conclusion: MPM-III scoring system was superior to SAPS-III regarding discrimination power in trauma patients. In addition, based on both systems, mortality rate was in direct association with days of ICU admission and intubation duration.

Keywords

References

  1. Herridge MS. Prognostication and intensive care unit outcome: The evolving role of scoring systems. Clin Chest Med 2003; 24(4): 751-62.
  2. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13(10): 818-29.
  3. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: A compendium. Indian J Crit Care Med 2014; 18(4): 220-8.
  4. Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Clay T, et al. Mortality probability model III and simplified acute physiology score II: Assessing their value in predicting length of stay and comparison to APACHE IV. Chest 2009; 136(1): 89-101.
  5. Goldhill DR, Withington PS. Mortality predicted by APACHE II. The effect of changes in physiological values and post-ICU hospital mortality. Anaesthesia 1996; 51(8): 719-23.
  6. Gilani MT, Razavi M, Azad AM. A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit. Niger Med J 2014; 55(2): 144-7.
  7. Alizadeh AM, Hassanian-Moghaddam H, Shadnia S, Zamani N, Mehrpour O. Simplified acute physiology score II/acute physiology and chronic health evaluation II and prediction of the mortality and later development of complications in poisoned patients admitted to intensive care unit. Basic Clin Pharmacol Toxicol 2014; 115(3): 297-300.
  8. Kramer AA, Higgins TL, Zimmerman JE. Comparison of the Mortality Probability Admission Model III, National Quality Forum, and Acute Physiology and Chronic Health Evaluation IV hospital mortality models: Implications for national benchmarking. Crit Care Med 2014; 42(3): 544-53.
  9. Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, Kramer AA. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Crit Care Med 2007; 35(3): 827-35.
  10. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270(20): 2478-86.
  11. Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Crit Care Clin 2007; 23(3): 639-58.
  12. Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med 2005; 31(10): 1336-44.
  13. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005; 31(10): 1345-55.
  14. Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med 2011; 39(1): 163-9.
  15. Kuzniewicz MW, Vasilevskis EE, Lane R, Dean ML, Trivedi NG, Rennie DJ, et al. Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders. Chest 2008; 133(6): 1319-27.
  16. Yaghoubi S, Abotorabi M, Naderi F, Arfaei E, Mohammadi A. Comparing APACHE (Acute Physiology and Chronic Health Evaluation) IV and SAPA(Simplified Acute Physiology Score) III methods in predicting mortality rate in patients admitted to intensive care unit. J Isfahan Med Sch 2014; 32(275): 201-11. [In Persian].
  17. Kashefi P, Saghaei M, Dehghani-Meibodi D. Comparison of Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scoring Systems on detection prognosis of mortality in patients with trauma admitted to the intensive care unit. J Isfahan Med Sch 2018; 36(478): 460-5. [In Persian].
  18. Shetabi H, Kashefi P, Heidari I. Comparison of Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III Scoring Systems in prediction of mortality in non-traumatic patients admitted to the intensive care unit. J Isfahan Med Sch 2018; 36(496): 1093-9. [In Persian].
Journal of Isfahan Medical School
Volume 37, Issue 522 - Serial Number 522
March and April 2019
Pages 350-356

Files

History

  • Receive Date: 21 November 2018
  • Revise Date: 20 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics