Assessment of patients’ severity and of the activity in the Fundeni Intensive Care Unit

Dana Tomescu, Horaţiu Popescu, Andrei Cristea
Centrul ATI, Institutul Clinic Fundeni, Bucureşti

Abstract

A correct evaluation of the complexity of care for critical patients has many variables, thus making it difficult to evaluate. Scoring systems are used to quantify severity, activity and results in intensive care.
The purpose of this study was to evaluate risk/mortality in our intensive care unit using scores such as APACHE II, SOFA/SAPS II and the activity using the OMEGA score, and to compare actual mortality according to the APACHE II severity score with published mortality.
Material and method. This is a prospective, noninteventional study, enrolling all consecutive patients (540) hospitalized for more than 24 hours during one year in the Fundeni – Intensive Care Unit.
APACHE II, SOFA/SAPS II and OMEGA were calculated for all patients.
Results. During the ICU stay, 40% of the patients had a maximum SOFA score over 12, and 60% under 12. In the first group, mortality was 65% and in the second one it was 50%. From this study, we concluded that the median values for the different scores were: 21 for APACHE II, 10 for SOFA and 141 for OMEGA.
Patients evaluated on grounds of APACHE II had a mortality that correlates with data from literature. Applying similar risk scores, the mortality was higher for surgical patients than for non-surgical patients.
Mortality was at least 50% if the SOFA score dynamically increased, 27-35% if the score was constant and less than 27% if it decreased. Independent of the initial score, the increases correlate with mortality over 50%. Activity in intensive care was quantified applying the OMEGA score, with maximal values ranging from 220 to 127 for survivors and for non-survivors respectively, which shows that much more activity is required for survivors.
Conclusions. Activity in the intensive care unit requires many resources: time, personnel, materials which should be reflected in results and which would demonstrate a department’s efficiency. Lack of qualified personnel and adequate resources can be considered as being possible causes for poor results.
Key words: severity score, activity score, SOFA, SAPS II, APACHE II, OMEGA

Evaluarea gravităţii pacienţilor şi a activităţii în Centrul de Terapie Intensivă Fundeni

Jurnalul Român de Anestezie Terapie intensivă 2007, Vol.14, Nr.2, 87-93