Evaluating APACHE II and APACHE IV Scoring Systems in Predicting Mortality Rate and Length of Hospital Stay in Patients with Head Trauma

Introduction: A series of criteria are developed to assess the patients' severity of illness in the ICU. Acute Physiology and Chronic Health Evaluation (APACHE) is a widely used scoring system (SS).  The current study aimed to determine the difference between APACHE II and APACHE IV scoring systems in predicting mortality rate and length of hospital stay in patients with head trauma referred to Poursina Hospital in Rasht.Methods: In this retrospective analytical study, medical records of patients hospitalized due to head trauma in the ICU of Poursina Hospital from February ۲۵, ۲۰۰۹, to August ۲۱, ۲۰۱۹, were studied.Results:  The mortality rate of ۱۴۷۲ ICU patients was ۳۹.۳%. The predicted mortality rate by the APACHE II SS before and after surgery was ۲۸.۷% and ۱۲.۸%, respectively; While APACHE IV predicted ۳۹% of deaths. The mean hospitalization duration of patients was ۱۵±۴۱.۳۵ days. Also, the mean ICU hospitalization was ۹.۷۷±۹.۲۴ days. Although, the mean estimated length of stay based on APACHE IV was ۶.۲۳ ۶۷±.۸ days. The APACHE IV SS underestimated the length of stay (p<۰.۰۰۱). According to the ROC chart, the best cut-off for APACHE IV was ۶۶, with a sensitivity of ۸۵.۸% and specificity of ۸۵.۴%. For APACHE II, the best cut-off score was ۲۰ with a sensitivity of ۸۶.۴% and specificity of ۸۱.۳%.Conclusion: Both APACHE II and APACHE IV SS can be used to predict the mortality of ICU patients, but APACHE IV is more effective and more accurate.

Keywords:

APACHE II , APACHE IV , Mortality rate , Length of Hospital Stay , Head trauma