Abstract | BACKGROUND: METHODS: Longitudinal 17-year prospective study of 11,314 ICU patients (academic/tertiary unit, Level I trauma center), 5,157 (45.5%) of whom developed any degree of MODS (Marshall score, cumulative). Data collected included Admission Acute Physiology and Chronic Health Evaluation (APACHE)-II and APACHE-III scores, MOD score (MODsc), hospital mortality, and the incidence and magnitude of MODS. The ratio of MODsc: APACHE III was calculated. Analyses (X +/- SEM, chi2, repeated-measures ANOVA, linear and polynomial regression, c-statistic) were performed for calendar-year intervals beginning in 1990 through 2006. RESULTS: Among MODS patients, the mean MODsc was 6.3 +/- 0.1 points, and the mortality rate was 22%. The APACHE III score increased significantly (p < 0.0001) over time, but the mortality rate was unchanged (r2 = 0.02). Adjusted for illness severity (MODsc:A3), the magnitude of MODS decreased significantly (p < 0.0001) during the time period. CONCLUSIONS: Despite significant increases in admission APACHE III score over 17 years, the adjusted magnitude of MODS (MODsc:A3) decreased. Given the strong association between MODS and mortality for critically ill surgical patients, it is likely that the unchanged risk-adjusted mortality observed over time is due to the reduced magnitude of MODS.
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Authors | Philip S Barie, Lynn J Hydo, Jian Shou, Soumitra R Eachempati |
Journal | The Journal of trauma
(J Trauma)
Vol. 65
Issue 6
Pg. 1227-35
(Dec 2008)
ISSN: 1529-8809 [Electronic] United States |
PMID | 19077606
(Publication Type: Journal Article)
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Topics |
- APACHE
- Aged
- Cause of Death
(trends)
- Critical Care
(methods, trends)
- Critical Illness
- Female
- Hospital Mortality
(trends)
- Humans
- Longitudinal Studies
- Male
- Mathematical Computing
- Middle Aged
- Multiple Organ Failure
(mortality, therapy)
- New York City
- Postoperative Complications
(mortality)
- Prospective Studies
- Software
- Survival Rate
- Trauma Centers
- Wounds and Injuries
(mortality, surgery)
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