• Shin Yan Man, Ka Man Chan, Fung Yi Wong, Kit Yi Wong, Chi Lap Yim, Paulina S K Mak, Chak Wah Kam, Chor Chiu Lau, Fei Lung Lau, Colin A Graham, and Timothy H Rainer.
• Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China.
• Resuscitation. 2007 Aug 1;74(2):259-65.

IntroductionNumerous prognostic predictive models have been developed for critically ill patients, many of which are primarily designed for use in intensive care units. The objective of this study was to evaluate the accuracy of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in predicting the mortality for critically ill patients managed in emergency department (ED) resuscitation rooms in Hong Kong.MethodA multi-centre, prospective study was conducted for patients managed in the resuscitation rooms of the EDs of four major hospitals, including one university teaching hospital. The primary outcome measure was 14 day all-cause mortality and the secondary outcome measure was the length of stay in hospital.ResultsOf 867 patients recruited between 4 and 30 April 2004, 106 (12.2%) patients died. The modified APACHE II score was found to be significantly higher in non-survivors compared to survivors (mean+/-S.D.: 21.2+/-7.7 versus 14.4+/-7.1, p<0.001). The area under the curve for modified APACHE II in predicting mortality was 0.743 (95% CI, 0.696-0.790).ConclusionThe modified APACHE II score is only a moderate predictor of mortality for critically ill patients managed in the resuscitation rooms of EDs in Hong Kong. A more ED specific scoring method is required.

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