“Prognostic Application of Simplified Acute Physiology Score in Critically Ill Patients inthe Medical Intensive Care Unit of aTertiary Care Hospital in India: A Prospective Study”
Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction and aim: Scoring systems in Critical Care units is a recent phenomenon. Multiple scoring systems are available today. Scoring systems either take into account the physiological derangement of the body or are end-organ damage scoring systems. In our study, we used the SAPS 2 scoring system to see the correlation between the score and mortality and the correlation with any factors if present. Materials and methods: A prospective observational study was performed in the Medical Intensive Care Unit of A.J. Hospital and Research Centre from October 1, 2023, to December 1, 2023. The SAPS 2 scoring model was applied on admission to all patients to measure the predicted ICU mortality. The standardized mortality ratio was computed by comparing the observed and predicted mortality rates. The study was conducted over two months and included 210 patients. The exclusion criteria for the study were the following: 1. Patients admitted to the Medical Intensive Care Unit and opting for termination of treatment by POLST (Physician Orders for Life-Sustaining Treatment) or EOLC (End of Life Care). In the above 2 scenarios, the recommended treatment would not be able to be administered due to the Physician’s orders and hence the decision to exclude the outcome from the study. 2. Patients opting for DAMA (Discharge Against Medical Advice). In those scenarios where the patient party opted to end treatment in the hospital and decided to continue treatment in other hospitals, due to financial reasons or otherwise, the outcome, even if they were improving at the time of discharge, was excluded from the study. In all, 16 patients either opted for End-of-life Care treatment or DAMA, hence they were excluded from the study. Results: During the study period, 192 patients were admitted to the MICU. Among them, 27 (14%) died in the ICU, while 165 (86%) survived. The observed ICU mortality was 14%. The standardized mortality ratio (SMR) was 0.47. But for those with SAPS II scores of 52 and more, it was 1.33. SAPS score of 52 showed sensitivity and specificity of 100% and 11.5% respectively. a score of higher than 52 corresponded with 100% mortality. There was also a correlation between multisystem involvement and mortality being greater than single-system involvement. Among age groups, 61-70 years of age had the greatest mortality compared to other age groups. Conclusion: The SAPS II scoring system correlates with mortality. In our study, a score of higher than 52 corresponded with 100% mortality. There was also a correlation between multisystem involvement and mortality being greater than single-system involvement. Among age groups, 61-70 years of age had the greatest mortality compared to other age groups. However, we advise that further studies be conducted on a bigger sample size to rule out any biases.
Author: Dr. Mohammed Imdad
Institution: JSS Academy of Higher Education and Research
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4402852377