Skip to main content

Acuity of Illness and Risk Prediction in Critically I11 Adults: The APACHE III Intensive Care Unit Management System

  • Chapter
Decision Support Systems in Critical Care

Part of the book series: Computers and Medicine ((C+M))

  • 88 Accesses

Abstract

Providing patients with state-of-the-art, quality care has been a hallmark of 20-century medicine. Critical care units developed as an extension of postoperative recovery rooms and with the dissemination of effective electronic electrocardiographic cardiac monitoring, external cardiac massage, and respiratory support. Intensive care units (ICUs) proliferated worldwide in an attempt to improve patient outcome and overall quality of care by concentrating technology in the hospital environment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Petty TL, Lakshminarayan S, Sahn SA, et al. Intensive respiratory care unit: review of ten years experience. JAMA 1975; 34:322–26.

    Google Scholar 

  2. Hook EW, Horton CA, Schaberg DR. Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 1983; 249:1055–1061.

    Article  PubMed  Google Scholar 

  3. Knaus WA, Wagner DP, Loirat P, et al. A comparison of intensive care in the U.S.A. and France. Lancet 1982; ii:642–46.

    Article  Google Scholar 

  4. Zimmerman JE, Knaus WA, Judson JA, et al. Patient selection for intensive care: a comparison of New Zealand and U.S. hospitals. Crit Care Med 1988; 16:318–26.

    Article  PubMed  CAS  Google Scholar 

  5. Knaus WA, Wagner DP, Draper EA, et al. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104:410–18.

    PubMed  CAS  Google Scholar 

  6. Abizanda R. The facilities. In Miranda DR, Williams A, Loirat P (eds): Management of the ICU-Guidelines for Better Use of Resources. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1990; pp 55–82.

    Google Scholar 

  7. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults, (in press).

    Google Scholar 

  8. Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II. JAMA 1990; 264:2389–2394.

    Article  PubMed  CAS  Google Scholar 

  9. Zimmerman JE, Shortell SM, Knaus WA, et al. An evaluation of outcome from 42 intensive care units: Risk adjusted mortality performance and factors associated with excellence, (in press).

    Google Scholar 

  10. Jencks SF, Williams DK, Kay TL. Assessing hospital-associated deaths from discharge data; the role of length of stay and comorbidities. JAMA 1988; 260:2240–46.

    Article  PubMed  CAS  Google Scholar 

  11. Park ER, Brook RH, Kosecoff J, et al. Explaining variations in hospital death rates-randomness, severity of illness, quality of care. JAMA 1990; 264:484–490.

    Article  PubMed  CAS  Google Scholar 

  12. Epstein AE. The outcomes movement-will it get us where we want to go? N Engl J Med 1990; 323:266–270.

    Article  PubMed  CAS  Google Scholar 

  13. Task Force on Guidelines-Society of Critical Care Medicine. Recommendations for intensive care unit admission and discharge criteria. Crit Care Med 1988; 16:807–808.

    Article  Google Scholar 

  14. Zimmerman JE (ed). APACHE III Study Design: Analytic plan for evaluation of severity and outcome. Crit Care Med 1989; 17:S-169–219.

    Google Scholar 

  15. Kalb, PE, Miller DH. Utilization strategies for intensive care units. JAMA 1989; 26:2389–2395.

    Article  Google Scholar 

  16. Jennett B. Resource allocation for the severely brain damaged. Arch Neurol 1976; 33:595–60.

    PubMed  CAS  Google Scholar 

  17. Killip T III, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 2150 patients. Am J Cardiol 1967; 20:457–464.

    Article  PubMed  Google Scholar 

  18. Ranson JHC, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974; 139:69–81.

    PubMed  CAS  Google Scholar 

  19. Knaus WA, Nystrom PO. Severity scoring and prediction of patient outcome. In Tinker J, Zapol (eds): Care of the Critically 111 Patient, ed 2. London: Springer-Verlag, 1989.

    Google Scholar 

  20. Cullen DJ, Civetta JM, Briggs BA, et al. Therapeutic intervention scoring system: A method for quantitative comparison of patient care. Crit Care Med 1974; 2:57–63.

    Article  PubMed  CAS  Google Scholar 

  21. Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE-Acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981; 9:591–96.

    Article  PubMed  CAS  Google Scholar 

  22. Zimmerman JE(ed). APACHE III study design: analytic plan for evaluation of severity and outcome. Crit Care Med 1989; 17s:169–S221.

    Google Scholar 

  23. Sirio CA, Knaus WA, Wagner DP, et al. Variation in risk adjusted hospital death rates: A national sample of intensive care units. Clin Res 1990; 38:281A.

    Google Scholar 

  24. Knaus WA, Draper EA, Wagner DP. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104:410–18.

    PubMed  CAS  Google Scholar 

  25. Examples of monitoring and evaluation in special care units. Joint Commission on Accreditation of Healthcare Organizations. Chicago, Illinois. 1988; 45–52.

    Google Scholar 

  26. Sax FL, Charlson ME. Utilization of critical care units: a prospective study of physician triage and patient outcome. Arch Intern Med 1987; 147:929–34.

    Article  PubMed  CAS  Google Scholar 

  27. Singer DE, Carr PL, Mulley AG, et al. Rationing intensive care: physician responses to a resource shortage. N Engl J Med 1983; 309:1155–60.

    Article  PubMed  CAS  Google Scholar 

  28. Strauss MJ, LoGerfo JP, Yeltatzie JA, et al. Rationing of intensive care unit: identifying patients at high risk of unexpected death or unit readmission. Am J Med 1988; 84:863–69.

    Article  Google Scholar 

  29. Bloomfield H, Moskowitz MA. Discharge decision-making in a medical intensive care unit: identifying patients at high risk of unexpected death or unit readmission. Am J Med 1988; 84:863–69.

    Article  Google Scholar 

  30. Wagner DP, Knaus WA, Draper EA, et al. Identification of low-risk monitor patients within a medical-surgical intensive care unit. Med Care 1983; 21:425–30.

    Article  PubMed  CAS  Google Scholar 

  31. Wagner DP, Knaus WA, Draper EA. Identification of low-risk monitor admissions to medical-surgical ICU’s. Chest 1987; 92:423–28.

    Article  PubMed  CAS  Google Scholar 

  32. McClish DK, Powell S. How well can physicians estimate mortality in a medical intensive care unit? Med Decis Making 1989; 9:125–30.

    Article  PubMed  CAS  Google Scholar 

  33. Brannen AL, Godfrey LJ, Goetter WE. Prediction of outcome from critical illness; a comparison of clinical judgement with a prediction rule. Arch Intern Med 1989; 149:1083–86.

    Article  PubMed  Google Scholar 

  34. Chang RW, Lee B, Jacobs S, et al. Accuracy of decisions to withdraw therapy in critically ill patients: clinical judgment versus a computer model. Crit Care Med 1989; 17:1091–97.

    Article  PubMed  CAS  Google Scholar 

  35. Bion JF, Edlin SA, Ramsay G, et al. Validation of a prognostic score in critically ill patients undergoing transport. Brit Med J 1985; 291:432–39.

    Article  CAS  Google Scholar 

  36. Chang RWS, Jacobs S, Lee B. Use of APACHE II severity of disease classification to identify intensive-care unit patients who would not benefit from total parenteral nutrition. Lancet 1986; ii: 1483–90.

    Article  Google Scholar 

  37. Ruark JE, Raffin TA. The Stanford University Medical Center Committee on Ethics: Initiating and withdrawing life support: Principles and practice in adult medicine. N Engl J Med 1988; 318:25–34.

    Article  PubMed  CAS  Google Scholar 

  38. Griner PF. The relationship between managerial and clinical decision making in the hospital. Med Decis Making 1988; 8:151–68.

    Article  PubMed  CAS  Google Scholar 

  39. Kellie S, Kelly JT. Medicare peer review organization preprocedure review criteria-an analysis of criteria for three procedures. JAMA 1991; 265:1265–1270.

    Article  PubMed  CAS  Google Scholar 

  40. Wennburg JE. Unwanted variations in the rules of practice. JAMA 1991; 65:1306–1307.

    Article  Google Scholar 

  41. Dubois RW, Rogers WH, Moxley JH, et al. Hospital inpatient mortality: is it a predictor of quality? N Engl J Med 1987; 317:1674–80.

    Article  PubMed  CAS  Google Scholar 

  42. Dubois RW, Brook RH. Preventable deaths; who, how often, and why? Ann Intern Med 1988; 109:582–89.

    PubMed  CAS  Google Scholar 

  43. Kahn KL, Brook RH, Draper D, et al. Interpreting hospital mortality data: how can we proceed? JAMA 1988; 260:3625–3628.

    Article  PubMed  CAS  Google Scholar 

  44. Knaus WA, Draper EA, Wagner DP, et al. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104:410–18.

    PubMed  CAS  Google Scholar 

  45. Draper EA, Russo M, Wagner DP, et al. Predicting tomorrow’s therapy using today’s APACHE II score. Clin Res 1990; 38:NEED.

    Google Scholar 

  46. Goldfield N, Nash D. Providing quality care: The challenge to clinicians; American College of Physicians, Philadelphia, PA, 1989; 159:452.

    Google Scholar 

  47. Sivak ED, Perez-Trepichio A. Quality assessment in the medical intensive care unit: evolution of a data model. Cleveland Clin J Med 1990; 57:273–79.

    CAS  Google Scholar 

  48. Murphy DJ, Cluff L (eds). SUPPORT: Study to understand prognosis and preferences for outcomes and risk of treatments: Study design. J Clin Epidemiol 1990:43(suppl);lS-123S.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag New York Inc.

About this chapter

Cite this chapter

Knaus, W.A., Sirio, C. (1994). Acuity of Illness and Risk Prediction in Critically I11 Adults: The APACHE III Intensive Care Unit Management System. In: Shabot, M.M., Gardner, R.M. (eds) Decision Support Systems in Critical Care. Computers and Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2698-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-2698-7_16

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-97799-7

  • Online ISBN: 978-1-4612-2698-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics