Louie Plenderleith

1

• Louie Plenderleith

2
New Case mix adjustment Systems
3
(No Transcript)
4
(No Transcript)
5
Scottish SMRs by APACHE system 2001.
6
Calibration
7
Apache II Exclusions

• 551 patients (6) excluded
• Age lt 16 yrs
• Stay lt 8 hours
• Diagnosis

8
Bundles
9

• Knaus WA, Draper EA, Wagner DP, et al
• APACHE II A severity of disease classification
• system.
• Crit Care Med 1985

10
Ideal Scoring System

• More Accurate
• Inclusive
• Same (or less) data
• Free

11
New Scoring methods

• SAPS 3 (2005)
• 19,507 patients, 305 ICUs, 4 Continents
• APACHE IV (2006)
• 131,618 patients, 104 ICUs, USA
• ICNARC Method (2007)
• 231,930 patients, 163 ICUs, England, Wales NI

12
ICNARC Calibration
13
SAPS 3 Calibration
14
APACHE IV Calibration
15
Exclusions

• APACHE IV
• Readmissions
• lt 16 years
• lt 4 hours
• Admitted from another ICU
• Hospital Stay gt 1 year
• SAPS 3
• Readmissions
• lt 16 years
• ICNARC
• Readmissions

16
Data collected currently
ICNARC model APACHE IV SAPS III
Heart rate Highest Most abnormal Highest
Temp Highest Most abnormal Highest
Respiratory Rate Lowest Most abnormal
Intubated Y /N
PaO2/FlO2 Both required Both Required Both required
Acid Base Lowest pH pCO2 / pH grid
Urea Highest Most abnormal
Creatinine Highest Most abnormal (Modified in ARF) Highest
Sodium Highest Most abnormal
Bilirubin Most abnormal Highest
Urine Output (24 hours) Yes Yes
Haematocrit Most abnormal
WBC Lowest Most abnormal Highest
Paralyzed/sedated? Yes (scored) Use GCS from up to 12 hours previously Use GCS from up to 12 hours previously
GCS Lowest (unless sedated) Grid lowest
Chronic Health Current list own list, but all present
Age Yes Yes yes
Source of Admission Yes Yes Yes
CPR additional coefficient
Length of Stay pre ICU Yes Yes
Type of surgery In Source of Admission
Planned or unplanned admission Planned or unplanned admission yes
17
Data not collected
ICNARC model APACHE IV SAPS III
BP Lowest systolic BP most abnormal MAP Lowest Systolic
Albumin Most abnormal
Glucose Most abnormal
Platelets Lowest
Diagnosis / reason for admission New list New list Limited list
Site of surgery Limited list
Preadmission Rx Inotropes
Acute infection at ICU Admission Acute infection at ICU Admission Yes / No
18
Cost

• SAPS 3 Public domain
• APACHE 4 Public domain
• ICNARC Not public Domain

19
Should we Change

• Loss of historical comparisons
• Probably no change in data collection burden
• Have to relearn definitions
• Will it work better for SICSAG?

20
What do we do?