• Spyridon Fortis, Amy M J O'Shea, Brice F Beck, Rajeshwari Nair, Michihiko Goto, Peter J Kaboli, Eli N Perencevich, Heather S Reisinger, and Mary V Sarrazin.
• Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA. Electronic address: spyridon-fortis@uiowa.edu.
• J Crit Care. 2018 Dec 1; 48: 237-242.

PurposeTo evaluate the performance of an automated computerized ICU severity scoring derived from the APACHE III.Materials And MethodsWithin a retrospective cohort of patients admitted to Veterans Health Administration ICUs between 2009 and 2015, we created an automated illness severity score(modified APACHE or mAPACHE), that we extracted from the electronic health records, using the same scoring as the APACHE III excluding the Glasgow Coma Scale, urine output, arterial blood gas components of APACHE III. We assessed the mAPACHE discrimination by using the area under the curve(AUC), and calibration by using the Hosmer-Lemeshow test and calculating the difference between observed and expected mortality across equal-sized risk deciles for death.ResultsThe ICU and 30-day mortality was 5.07% of 7.82%, respectively (n = 490,955 patients). The AUC of mAPACHE for ICU and 30-day mortality was 0.771 and 0.786, respectively. The Hosmer-Lemeshow test was significant for both ICU and 30-day mortality (p < .001). The absolute difference between observed and expected mortality did not exceed ±1.53% across equal-sized deciles of risk for death. The AUC for ICU mortality was >0.7 in all admission diagnosis categories except in endocrine, respiratory, and sepsis. The AUC for 30-day mortality was >0.7 in every category.ConclusionmAPACHE has adequate performance to predict mortality.Copyright © 2018 Elsevier Inc. All rights reserved.

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