Indications of admitting patients in internal ICU and the rate of mortality in Emam Khomeini hospital in 2013
Keywords:Indication, Intensive care unit, Mortality
Background: ICU is the costly part of the hospital that has functional approach for patients who have reversible conditions so it needs mechanical ventilation and other special services. Some patients are not really in need of special care only the continuous monitoring of vital signs needs of the public sector. Patients with good condition or End-Stage were not candidate to admitting in ICU. The aim of this study was to evaluate indications of admitting patients in internal ICU and the rate of mortality in Emam Khomeini hospital in 2013.
Methods: The study was conducted retrospectively evaluated the records of patients hospitalized in ICU and disease prognosis and treatment of disease and APACHE2 criteria was analyses.
Results: The mean age of patients in the study was 61.05±19.81. Of 118 patients, 70 (59.3%) survived and 48 (40.7%) patients died. APACHE2 mean in the study was 21.46±7.5. GCS average was 9.83±4.27. There was correlation between mortality of patients and type of disease. In this study in APACHE2 score between 25-29 and >35 in mortality rate we are higher than standard average and in 10-14 and 20-24 we are lower than standard average.
Conclusions: This study shows that GCS is not a good measure for the evaluation of patients hospitalized in internal ICU. In the present study, patients with higher APACHE2 score of 35 died. That show hospitalization that patient in ICU has no difference in the prognosis of them. As regards mortality rate in ICU patients in this study has no significant difference with predicted APACHE values, indications of ICU admition in Emam Khomeini hospital observed exactly.
Admission, Discharge Criteria and Triage. ICU Management Protocol No. 1. NAICU/ Management Protocol/ Admission Discharge and Triage; 2006.
Norouzi K, Mashmool Z, Dalvandi A, Soleimani M A. Comparison of two tools APACHE IV and SAPS II in predicting mortality rate in patients hospitalized in intensive care unit. Koomesh. 2015;16:347-55.
Giannini1 A, Consonni D. Physicians’ perceptions and attitudes regarding inappropriate admissions and resource allocation in the intensive care setting. Br J Anaesth. 2006;96:57–62.
Nasraway SA, Cohen IL, Dennis RC, Howenstein MA, Nikas DK, Warren J, et al. Guidelines on admission and discharge for adult intermediate care units. Crit Care Med. 1998; 26:607-10.
El-Nabulsi BA, Holy M, Al-Suleihat A, Smadi S. Appropriateness of admission to intensive care unit. JRMS. 2005;12:6-9.
Nguyen JM. A universal method for determining intensive care unit bed requirements. Intensive Care Med. 2003;29:849–52.
Sovari A. Who Should Be Admitted to the Intensive Care Unit? Carle Selected Papers. 2007;50:1.27-35.8.
Garrouste-Orgeas M, Montuclard L, Timsit JF, Misset B, Christias M, Carlet J. Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes. Intensive Care Med. 2003;29:774–81.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9:591-7.
Le Gall JR. The use of severity scores in the intensive care unit. Intensive Care Med. 2005;31:1618-23.
Khwannimit B, Geater A. A comparison of APACHE II and SAPS II scoring systems in predicting hospital mortality in Thai adult intensive care units. J Med Assoc Thai. 2007;90:643-52.
Matic I, Titlic M, Dikanovic M, Jurjevic M, Jukic I, Tonkic A. Effects of APACHE II score on mechanical ventilation; prediction and outcome. Acta Anaesthesiol Belg. 2007;58:177-83.
Polderman KH, Jorna EM, Girbes AR. Inter-observer variability in APACHE II scoring: effect of strict guidelines and training. Intensive Care Med 2001;27:1365-69.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
Keegan MT, Gali B, Findlay JY, Heimbach JK, Plevak DJ, Afessa B. APACHE III outcome prediction in patients admitted to the intensive care unit after liver transplantation: a retrospective cohort study. BMC Surg. 2009;9:11.
Chen YC, Lin MC, Lin YC, Chang HW, Huang CC, Tsai YH. ICU discharge APACHE II scores help to predict post-ICU death. Chang Gung Med J. 2007;30:142-50.
Fadaii A, Sohrabpour H. Serum Troponin Levels, APACHE II Score and Mortality Rate for Non-Cardiac Reasons in RCU Patients. J Respir Dis, Thoracic Surg Intensive Care Tuberculosis 2009;1:29-34.
Ratanarat R, Thanakittiwirun M, Vilaichone W, Thongyoo S,Permpikul C. Prediction of mortality by using the standard scoring systems in a medical intensive care unit in Thailand. J Med Assoc Thai. 2005;88:949-55
Atiyat B, Kloub A, Abu-Ali H, Massad I. Clinical Sense in the Prediction of Surgical/Trauma Intensive Care Mortality. Eur J of Sci Res. 2009;30:265-71.
Mohammadi H, Haghighi M. Survey Relationship of Mortality Rate of Hospitalized Patients in ICU with Different Degrees of APACHE II. J Guilan Univ Med Sci. 2006;15:85-90.
van Berkel A, van Lieshout J, Hellegering J, van der Hoeven JG, Pickkers P. Causes of death in intensive care patients with a low APACHE II score. Neth J Med. 2012;70:455-9.
Molavi M, Kayalha H, Seddighi A. Comparison of Acute Physiology and Chronic Health Evaluation Score with Glasgow Coma Scale for predicting hospital mortality in neurosurgical patients. JQUMS. 2013;17:58-62
Soleimani MA, Masoudi R, Bahrami N, Qorbani M, Sadeghi T. Predicting mortality rate of patients in critical care unit using APACHE-II index. J Gorgan Uni Med Sci. 2010;11:64-9
Yasemi M, Hemmati K, Khodadadi I, Yasemi M. Prognosis Evaluation in Hospitalized ICU Patients According to APACHE II. JAP. 2014;4:41-51.