|Title||The Usefulness of the APACHE II Score in Obstetric Critical Care: A Structured Review.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Ryan, H, Sharma, S, Magee, LA, Ansermino, JM, MacDonell, K, Payne, BA, Walley, K, von Dadelszen, P|
|Journal||J Obstet Gynaecol Can|
|Date Published||2016 10|
|Keywords||APACHE, CIPHER, Critical Care, Female, Humans, Obstetric Surgical Procedures, Pregnancy, Pregnancy Complications, Socioeconomic Factors|
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review.
DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015.
STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses. Ten studies were from high-income countries (HICs), and 15 were from low- and middle-income countries (LMICs). Median study duration and size were six years and 124 women, respectively.
DATA SYNTHESIS: ICU admission complicates 0.48% of deliveries, and pregnant and recently pregnant women account for 1.49% of ICU admissions. One quarter were admitted while pregnant, three quarters of these for an obstetric indication and for a median of three days. The median APACHE II score was 10.9, with a median APACHE II-predicted mortality of 16.6%. Observed mortality was 4.6%, and the median standardized mortality ratio was 0.36 (interquartile range 0.23 to 0.73). The standardized mortality ratio was < 0.9 in 24 of 25 studies. Women in HICs were more frequently admitted with a medical comorbidity but were less likely to die than were women in LMICs.
CONCLUSION: The APACHE II score consistently overestimates mortality risks for pregnant and recently pregnant women receiving critical care, whether they reside in HICs or LMICs. There is a need for a pregnancy-specific outcome prediction model for these women.
|Alternate Journal||J Obstet Gynaecol Can|