Experience with the APACHE II severity of disease scoring system in predicting outcome in a surgical intensive therapy unit

The APACHE II system, a severity of disease scoring system, has been used to identify intensive therapy unit patients in whom prolonged treatment is unlikely to be beneficial. Fifty-nine surgical patients admitted to the intensive care unit over a 6-month period underwent a single APACHE II scoring in the first 24 h. The overall 30-day mortality rate was 34%. The range of APACHE II scores was 3-29. The survivors had significantly lower scores (mean 11) than those who died (mean 19). Most patients (53%) had a score greater than or equal to 11 to less than or equal to 22 and had an equal chance of living or dying. No patient with a score greater than 22 survived and at this level the APACHE II score was highly specific (100%) but with a very low sensitivity (30%). APACHE II scores greater than 22 may be useful as an adjunct to a clinical decision to withhold treatment, but scores below that level lack the specificity and sensitivity to be of any value.