Studies evaluating the impact of long-term acute care (LTAC) hospitals on patient outcome have focused on patients requiring mechanical ventilation. In this context, LTAC hospitals have been compared with other types of weaning units. Survival until discharge in these settings ranged between 48% and 93%, and long-term survival ranged from as low as 23% at 1 year to as high as 53% at 4 years. The variability in reported success may be explained by differences among hospital admission criteria, case mix, and referral patterns. The primary aim of our study was to determine if survival of a cohort of patients admitted to an LTAC hospital could be predicted by age, race, number of residual organ system failures (OSFs) at the time of admission to the LTAC hospital, or APACHE III score at the time of admission to the LTAC.
A number of models exist that predict survival in the ICU setting. One such early model was developed using cumulative OSFs over 7 days. The most well-known prognostic systems are those of APACHE medical systems, APACHE II and APACHE III scores, which describe a method for assessing group death rates among ICU admissions using first-day risk assessment. While of limited value for individual management decisions, they are useful for risk stratification, research, quality assurance, and utilization review. APACHE III is a proprietary tool. Other scoring systems include the Sequential Organ Failure Assessment, Therapeutic Intervention Scoring System, Mortality Prediction Model, and the Simplified Acute Physiology Score II. Most prognostic scoring systems, similar to APACHE, use the worst values in the first 24 h after ICU admission and thus do not account for the impact of response to therapy on prognosis. Serial reprognostication using modified APACHE III formulas was hoped to yield a dynamic risk of death with more reliable estimates of individual risk. The probability of survival decreased when the acute physiology score (APS) component of the modified APACHE III score increased over the first several days; it also increased, to a lesser degree, when the APS failed to improve. Canada pharmacy – cheap viagra, cialis, kamagra online.
Caution must be used when applying a model to a population other than that in which it was developed. APACHE III, when applied to a group of ICUs in the United Kingdom, overestimated death and had poor calibration and uniformity of fit. No predictive or descriptive models, to the best of our knowledge, have been developed in patients surviving the acute phase of critical illness requiring LTAC. Our objective was to determine the extent to which survival in these patients is associated with age, race, residual OSFs, or APACHE III score on admission to LTAC.