Ulus Travma Acil Cerrahi Derg. 2020; 26(6): 893-898 | DOI: 10.14744/tjtes.2020.22654

APACHE II or INCNS to predict mortality in traumatic brain injury: A retrospective cohort study

Güven Gürsoy¹, Canan Gürsoy², Yaðmur Kuþcu³, Semra Gümüþ Demirbilek^3
1Department of Neurosurgery, Muðla Sýtký Koçman University Training and Research Hospital, Muðla-Turkey
²Division of Intensive Care, Department of Anesthesiology and Reanimation, Muðla Sýtký Koçman University Training and Research Hospital, Muðla-Turkey
³Department of Anesthesiology and Reanimation, Muðla Sýtký Koçman University Faculty of Medicine, Muðla, Turkey

BACKGROUND: Some scoring systems, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), are used to predict mortality, but they are not specialized for traumatic brain injury. INCNS is a new scoring system for traumatic brain injury developed by Goa et al. INCNS score evaluates inflammation, nutrition, consciousness, neurological function and systemic condition. The present study aims to evaluate performances of Acute Physiology and Chronic Health Evaluation II (APACHE II) and INCNS to predict mortality in traumatic brain injuries.
METHODS: In this study, 78 patients who were treated in anaesthesiology intensive care unit with the diagnosis of traumatic brain injury were included. Patients under the age of 18, foreigners, patients with incomplete data were excluded from this study. Medical records were examined retrospectively. APACHE II and INCNS scores in the first 24 hours were counted up.
RESULTS: Of the 78 patients, 45 (57.7%) were males and 33 (42.3%) were females. The overall mortality was 34.6% (27/78). The mean APACHE II, INCNS score was 23.85±9.44 and 14.43±8.75, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.797 for the APACHE II and 0.847 for the INCNS.
CONCLUSION: The INCNS scoring system had higher discriminatory power than the APACHE II in predicting the mortality of TBI in the ICU. INCNS can be considered as a usable prognostic model for Turkish people.

Keywords: Acute Physiology and Chronic Health Evaluation II (APACHE II), INCNS scoring system; intensive care unit mortality; scoring system; traumatic brain injury.

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Travmatik beyin hasarýnda mortaliteyi tahmin etmede APACHE II mi INCNS mi?: Geriye dönük kohort çalýþma

Güven Gürsoy¹, Canan Gürsoy², Yaðmur Kuþcu³, Semra Gümüþ Demirbilek^3
1Muðla Sýtký Koçman Üniversitesi Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Muðla
²Muðla Sýtký Koçman Üniversitesi Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Yoðun Bakým, Muðla
³Muðla Sýtký Koçman Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Muðla

AMAÇ: Mortaliteyi belirlemede akut fizyoloji ve kronik saðlýk deðerlendirme II (APACHE II) skorlama sistemi gibi birçok skorlama sistemi kullanýlmasýna raðmen travmatik beyin hasarýna özgü deðildir. INCNS travmatik beyin hasarý için Gao ve ark. tarafýndan geliþtirilmiþ yeni bir skorlama sistemidir. INCNS skorlama sistemi, enflamasyon, nutrisyon, bilinç, nörolojik fonksiyonlar ve sistemik durumu deðerlendirmektedir. Çalýþmamýzýn amacý travmatik beyin hasarýnda mortaliteyi tahmin etmede APACHE II ve INCNS’nin performansýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Travmatik beyin hasarý nedeniyle anestezi yoðun bakým ünitesinde tedavi edilen 78 hasta çalýþmaya alýndý. Hastalarýn týbbi kayýtlarý geriye dönük olarak incelendi. On sekiz yaþýndan küçük olanlar, yabancýlar, eksik verileri olan hastalar çalýþma dýþý býrakýldý. Hastalarýn ilk 24 saat içindeki verileri ile APACHE II ve INCNS skorlarý hesaplandý ve kayýt edildi.
BULGULAR: Yetmiþ sekiz hastanýn 45’i (%57.7) erkek, 33’ü (%42.3) kadýndýr. Mortalite oraný %34.6 (27/78) olarak hesaplanmýþtýr. APACHE II ve INCNS skorlarýnýn ortalamasý sýrasýyla 23.85±9.44 ve 14.43±8.75’dir. ROC eðrisi altýnda kalan alan APACHE II için 0.797, INCNS için 0.84’dür.
TARTIÞMA: INCNS skorlama sistemi; yoðun bakým ünitesinde travmatik beyin hasarý mortalitesini belirlemede APACHE II skorlama sistemine göre daha güçlüdür ve Türk hasta popülasyonuna uygun olduðu söylenebilir.

Anahtar Kelimeler: Akut fizyoloji ve kronik saðlýk deðerlendirme II (APACHE II), INCNS skorlama sistemi; skorlama sistemi; travmatik beyin hasarý; yoðun bakým ünitesi mortalitesi.

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