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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of standard and modified severity of illness scores in the obstetric patient
Journal of Critical Care, Volume 26, No. 5, Year 2011
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Description
Purpose: To test discrimination and calibration of APACHE-II and SAPS-II risk prediction scores in a cohort of obstetric patients, and to evaluate the effect of modifying these scores for the physiological changes in pregnancy. Materials and Methods: A retrospective review of obstetric patients, 12 weeks gestation to 48 hours postpartum, admitted to the ICU for more than 24 hours. APACHE-II and SAPS-II, and versions modified for the physiological changes of pregnancy, were evaluated by receiver operating characteristic (ROC) curves and standardized mortality ratios (SMR). Multivariable analysis identified other parameters associated with mortality. Results: Data were obtained from 332 patients from 5 countries, with a mortality rate of 12%. Mean (± SD) APACHE-II score was 16.8 ± 6.1 and SAPS-II score 26.5 ± 15.8. Good discrimination was demonstrated with area under the ROC curves of 0.82 and 0.78 respectively, with no improvement after modification for altered maternal physiology. APACHE-II overestimated mortality, with an SMR of 0.43 (0.52 after including diagnostic weighting) compared with 0.89 for SAPS-II. Bilirubin, albumin and Glasgow Coma Scale were independently associated with mortality. Conclusion: APACHE-II and SAPS-II are good discriminators of illness severity and may be valuable for comparing obstetric cohorts, but APACHE-II significantly over-estimates mortality. © 2011 Elsevier Inc.
Authors & Co-Authors
Lapinsky, Stephen Earl
Canada, Toronto
University of Toronto
Hallett, David
Canada, Toronto
University of Toronto
Collop, Nancy
United States, Baltimore
Johns Hopkins University
Drover, John W.
Canada, Kingston
Queen’s University
Lavercombe, Peter
Australia, Spring Hill
St Andrew's War Memorial Hospital
Leeman, Marc J.
Belgium, Brussels
Hôpital Erasme
Moola, Shiraz
Canada
Kootenay Lake Hospital
Paruk, Fathima P.
South Africa, Johannesburg
University of the Witwatersrand
Bernstein, Michael
Canada, Toronto
University of Toronto
Moodley, Jagdisea M.
South Africa, Durban
University of Kwazulu-natal
Statistics
Citations: 51
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1016/j.jcrc.2010.10.003
ISSN:
08839441
e-ISSN:
15578615
Research Areas
Health System And Policy
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study