| Summary: | 碩士 === 慈濟大學 === 護理學系碩士班 === 106 === Background : The disease severity scoring system is the basis for determining if a patient will enter the intensive care unit (ICU) and also as a means of predicting death. Over the past 30 years, it has been and continues to be one of the important indicators used to promote the quality of medical care. APACHE II is the most commonly used disease severity scoring system in the world. Deaths in the intensive care unit are closely related to sepsis and organ dysfunction/failure. SOFA has been developed as a disease severity assessment system for patients with septicemia. The recommended time for utilizing these two assessment systems is within the first 24 hours of transfer to the intensive care unit when patients’ data records are at their worst levels. The current clinical procedure, however, is to use the data at the time of admission. In recent years, countries around the world have compared the APACHE II and SOFA scores at different time points for the purpose of death prediction, but in Taiwan there are currently no similar research studies available.
Research purposes : The aim of this study is to understand how effective the use of these two systems is for predicting the risk of death in intensive care unit patients, and to determine the optimal assessment time for predicting death in ICU patients. This information can then serve as a reference for medical decision-making and clinical care.
Research methods : This study used the medical record retrospective study method to study the internal medicine patients who were admitted to the intensive care unit from January 01, 2017 to June 30, 2017. The research tools consisted of self-designed questionnaires, APACHE II, SOFA and CCI evaluation forms. The two nurse practitioners individually collected and scored the data. The average scores of the two evaluators were divided into a “death group” and a “survival group” for descriptive statistical purposes. Continuous variables such as age, hospitalization days and evaluation scores were averaged and the standard deviation determined. The category variables such as transfer source, gender, etc., presented in frequency and percentage. Inference statistics were compared with the survival group by the independent T test and the chi-square test. The p value <0.05 was considered as significant difference; correlation was made between APACHE II and SOFA scores using the Pearson correlation test; Paired T test was used to compare both the APACHE II and SOFA original and retrospective scores; logistic regression was used to find the correlation between the APACHE II & SOFA scores as they relate to the occurrence of death; the ability of the two scoring systems to predict death was assessed using the area under the curve of receiver operating characteristic (AUCROC).
Results and Care Applications: APACHE II is associated with SOFA disease severity assessment scores; 24-hour retrospective APACHE II and SOFA assessment scores are higher than those assessed in the original intensive care unit assessment; the higher the APACHE II and SOFA assessment scores, the higher the mortality rate; increased CCI comorbidity index and the SOFA score combined prediction did not significantly improve the ability to predict death. Based on the results of this study, it is recommended to increase the 24-hour retrospective assessment of the severity of the disease and to present a trend of progression. It is also recommended to arrange ongoing clinical education for the purpose of increasing the degree of consistency in assessment.
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