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Comparison of two predictive models for prognosis in critically ill patients in a Veteran's Affairs Medical Center coronary care unit.

STUDY OBJECTIVE
The acute physiologic and chronic health evaluation score has been developed to assess prognosis in critically ill patients. Knaus et al initially determined and validated diagnosis-specific coefficients for prediction of outcome in a group of multidisciplinary ICUs. Teskey et al found different coefficients for cardiac diagnoses in a retrospective analysis of coronary care unit (CCU) only patients. This study compares the actual mortality in a Veteran's Affairs Medical Center (VAMC) CCU with the mortality predicted by the two equations.


DESIGN AND SETTING
Data were prospectively collected for patients admitted to the medical CCU at a university-affiliated, tertiary care VAMC.


PATIENTS
Patients (n = 338) admitted to the CCU with the diagnoses of coronary artery disease (CAD), myocardial infarction (MI), congestive heart failure (CHF), arrhythmia (Arr), and other cardiac-related diagnoses.


RESULTS
The entire CCU population showed no significant differences from either the predictions by Knaus et al and Teskey et al in 1991. However, when specific disease states were analyzed as a whole, significant differences from both prediction models for CAD and MI actual mortality were found. Teskey et al was a better predictor for the Arr and CHF population, while both were equally reliable for other.


CONCLUSIONS
Either prediction model is reliable for a CCU population in general. However, diagnosis-specific coefficients of Teskey et al appear to correlate better with actual mortality for this VAMC. Significant outcome differences compared with those predicted may reflect the patient population specific to a VAMC.