Abstract

Background: The objective of intensive care units is to modify mortality caused by the onset of acute failure of one or more organ systems. However, in practice, diverse criteria are used, such as ethical and moral factors, bed availability, lack of intermediate monitoring areas, and various reasons that lead to high hospital costs. Disease severity indices such as the MPM (Mortality Probability Models) and APACHE (Acute Physiology and Chronic Health Evaluation) scores should be useful in the pre-admission stage and during the patient's stay in the ICU in order to rationalize therapeutic interventions. It must be acknowledged, however, that they are impractical when we are called upon to determine ICU admission.

Methods: All patients admitted to the Intensive Care Unit of the Angeles Metropolitano Hospital, of septic and non-septic origin, were studied. The APACHE II (Acute Physiology and Chronic Health Evaluation) scores and SAPS III (Simplified Acute Physiology Score) variables were determined. The determination is made through the intervals, which include APACHE> 30 points, APACHE: 20-30 points, and APACHE <30 points and concomitantly; the SAPS III was calculated for each group, the mortality percentage was determined and through the accounts department, the daily cost per department and segment assigned to the patients was obtained to define the unit cost. The APACHE II and SAPS III determination was performed upon admission and 48 hours later, data collection was done in a format specially designed for the study.

Results: A total of 48 patients were admitted during the study period, 47.91% were male. The mean age was 55.79 ± 18.5 years. APACHE scores were determined with intervals: + 30 points: 5 patients, 20-30 points: 11 patients, and -20 points: 32 patients. The number of deaths according to the APACHE intervals: > 30 points: 4 patients, 20-30: 5 patients, <20: 2 patients. The overall mortality was 22.91%. Days of stay for APACHE intervals:> 30: 2 ± 2.2 days/patient, 20-30: 10 ± 12.9 days/patient and <20: 5.70 ± 4.8 days/patient, costs according to APACHE upon admission: >30 points = Total = $41,911.92 USD (cost/day: $8,382.39 ± 10,829.11 USD), 20-30 points: $147,017.87 USD (cost day: $12,966.24 ± 9,629.25 USD), <20 points: $409,875.09 USD (cost/day $12,809.76 ± 11,120.14 USD). APACHE <20: SAPS III 47.5313 ± 11.21 points, mortality 20.0938 ± 14.074%. APACHE 20-30: SAPS III 61.66 ± 18.31 points, mortality 48.6333 ± 23.3274%. APACHE > 30: SAPS III 78.00 ± 15.18223 points, mortality 65.0 ± 20.78461%.

Conclusions: It is observed that the highest cost is in patients with an APACHE < 20 points, but with a greater number of days of stay and with a greater survival rate, and it is expected that the highest number of deaths can be observed with APACHE score levels > 30 points, as well as in the range of 20-30 points.

Keywords

bed availability,initiating therapeutic measures,determine ICU admission