The revised Acute Physiology and Chronic Health Evaluation System (APACHE II) is more effective than the Glasgow Coma Scale for prediction of mortality in head-injured patients with systemic trauma

BACKGROUND
The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. Nevertheless, the necessity of using a more complex system than GCS has been questioned recently. The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS. In addition, it is thought to be superior to GCS due to recognition of increasing age and significant chronic health problems, which adversely affect mortality.
METHODS
This retrospective study included 266 patients (195 males, 71 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2003 and 2004.
RESULTS
Mortality increased in the elderly group (p<0.001). Mean survival score in APACHE II was 38.0 and death score was 68.7 (p<0.001); these values in GCS were 10.4 and 6.3, respectively (p<0.001). APACHE II at the cut-off point was better than GCS in the prediction of death and survival in patients (p<0.01). The area under the receiver operating characteristic curve for sensitivity and specificity was larger in APACHE II (0.892±0.028) than GCS (0.862±0.029).
CONCLUSION
For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.

Sistemik travma geçirmiþ kafa travmalý olgularýn mortalite tahmininde ‘Düzeltilmiþ Akut Fizyoloji ve Kronik Saðlýk Deðerlendirme Sistemi’ (APACHE II), Glasgow Koma Skorundan daha üstündür

AMAÇ
Glasgow Koma Skoru (GKS) yaygýn, basit, güvenli ve travma hastalarýnýn bilinç deðerlendirilmesinde iyi bir iletiþim skalasýdýr. Ancak, son yýllarda GKS’den daha ayrýntýlý bir sistem gerekliliði sorgulanmaktadýr. Düzeltilmiþ akut fizyoloji ve kronik saðlýk deðerlendirilmesi sistemi (APACHE II) GKS ile birlikte 12 fizyolojik parametre içeren fizyolojik temelli bir skaladýr. Ayrýca mortaliteyi etkileyen kronik hastalýk ve ileri yaþ deðiþkenlerini de içermesi GKS’den daha üstün olduðunu düþündürmektedir.
GEREÇ VE YÖNTEM
Bu çalýþmada, 2003 ve 2004 yýllarýnda kafa travmasý ile birlikte sistemik travma geçirmiþ 266 olgu (195 erkek,71 kadýn; ort. yaþ 60,5; daðýlým 14-87) geriye dönük olarak deðerlendirildi.
BULGULAR
Mortalite ileri yaþ grubunda artmýþtý (p<0,001). Ortalama APACHE II skoru yaþayanlarda 38,0, ölen olgularda 68,7 (p<0,001), ortalama GKS puaný yaþayanlarda 10.4 ölen olgularda 6,3 (p<0,001) bulundu. Mortalite tahmininde APACHE II GKS’den daha belirgin sýnýr puaný saðladý (p<0,001). Duyarlýlýk ve özgünlük için yapýlan ROC eðrisinde, APACHE II (0,892±0,028) eðrisi altýnda kalan alan GKS’den daha büyüktü (0,862±0,029).
SONUÇ
Mortalite deðerlendirmesinde, özellikle acil servislerde GKS kafa travmalý olgularda yeterli öngörü saðlayan, basit ve kolay uygulanmakla birlikte sistemik travma geçirmiþ olgularda APACHE II hastanýn önemli fizyolojik parametrelerini de içermesi nedeniyle GKS’den üstündür.