Chest
Clinical Investigations in Critical CareThe APACHE III Prognostic System: Risk Prediction of Hospital Mortality for Critically III Hospitalized Adults
Section snippets
PATIENTS AND METHODS
The two major analytic steps in developing APACHE III were (1) the collection of an appropriate data base and (2) analysis to establish a final system design. First, we assembled a list of candidate variables and questions for each of the five major predictive constructs (major disease categories, acute physiology, age, comorbidities, and origin and timing of patient selection).
RESULTS
The majority (89 percent) of the 40 hospitals were nonprofit, and 54 percent were affiliated with a medical school. The average number of hospital beds was 359, the average number of ICU beds was 21, and the average number of ICU beds was 13. These characteristics reflect national statistics on the 1,691 US hospitals with 200 or more beds. Of the 42 ICUs studied, 71 percent were mixed medical-surgical, 16 percent were surgical, 10 percent were medical, and 3 percent represented other
CONCLUSION
Every day, clinicians and physicians engaged in clinical research make complex decisions regarding the scope and intensity of treatment or the potential value of new therapies that might be supported or enhanced by an accurate and objective measurement of patient risk. Indeed, many of the most important questions concerning the quality and appropriateness of advanced medical care cannot be fully addressed until patient risk is accurately assessed and reliably recorded. The completion of the
FINANCIAL DISCLOSURE
All the authors certify that affiliations with or involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in this article are disclosed as follows: Drs Knaus, Wagner, and Zimmerman and Ms Draper are each founders and minority equity shareholders of APACHE Medical Systems, Inc (AMS), a for-profit Delaware-based corporation that funded, in part, the research for the APACHE III study. AMS markets a software-based clinical information
ACKNOWLEDGMENTS
We would like to acknowledge the institutions that participated in the APACHE III data collection: St Mary's Hospital, East St Louis; White Memorial Hospital, Los Angeles; United Hospital, Clarkcsboro, WV; St Lukes-Roosevelt, New York; Cooper Medical Center, Camden, NJ; Monongahela Valley Hospital, Monongahela, Pa; Easton Hospital, Easton, Md; Burlington Medical Center, Burlington, Ia; Union Hospital, Union, NJ; St Lukes Hospital, Newburgh, NY; Wyandotte Hospital/Medical Center, Wyandotte,
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Supported by the Agency for Health Care Policy and Research (grant No. HS05787); The John A. Hartford Foundation (grant No. 87267); the Department of Anesthesiology, George Washington University Medical Center; and APACHE Medical Systems, Inc. Dr Bastos was supported by a grant from the National Council of Scientific and Technology Development (CNPq), Brazil.
Manuscript received May 15; revision accepted August 13.