Journal of the Royal Society of Medicine
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In this paper we present a detailed analysis of the use of the APACHE II (acute physiological and chronic health evaluation) scoring system on all of the patients admitted to the general intensive care unit at the Bristol Royal Infirmary over a 20-month period. The 6-month survival of 691 adult medical and surgical patients following intensive care was recorded and this data was analysed with admission and daily APACHE II scores using a relational database. ⋯ We also demonstrate that the best day one scores are approximately 50% less than the admission score, irrespective of outcome, indicating the benefit of intensive care. By contrast, however, the scores on day one have either not improved or have worsened since admission, reflecting the importance of the pre-morbid health status of the patient in determining outcome from intensive care.
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Head injuries are expensive and demanding in terms of resources. In the UK, most are cared for outside neurosurgical centres. In the absence of specialist rehabilitation services, patients with on-going disability add to those admitted for observation and treatment on acute surgical wards. ⋯ The direct cost of these head injuries patients was estimated at 173,500 pounds, during which time they occupied 7.6% of our unit's adult inpatient capacity. Twenty-four hour observation of 76 patients with minor head injuries contributed 9700 pounds (5.6%) to this figure. Associated extracranial injuries cost a further 46,500 pounds.(ABSTRACT TRUNCATED AT 250 WORDS)