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Critical Care

Open Access

Comparison between APACHE II and POSSUM 2 scores in neurosurgical patients admitted to an ICU in Fortaleza, Brazil

  • AA PeixotoJr1, 2,
  • MNR Teixeira Henderson3,
  • CAR Feijó3,
  • VN Araújo3,
  • ZC Teixeira3,
  • RE Magalhães1, 3 and
  • FA de Meneses1, 3
Critical Care201317(Suppl 3):P33

Published: 19 June 2013


The need to stratify surgical risk is essential to assess the quality of care of patients undergoing intervention. The objective of this study was to compare APACHE II and POSSUM 2 severity scores in patients undergoing neurosurgery, in the immediate postoperative period.


An observational prospective study with 155 patients admitted consecutively to the ICU of a tertiary hospital in Fortaleza, Brazil, from December 2011 to June 2012, after neurosurgical intervention. Results The population analyzed showed an average age of 48.0 ± 15.8 years, predominantly female (55.3%). Elective surgeries were more prevalent (92.1%), especially aneurysm clipping (14.6%) and resection of neoplasm (64.2%). At admission, 45 patients (27.6%) had at least one organ dysfunction. The APACHE II score mean was 9.7 ± 5.1, corresponding to the mean of predicted mortality of 14.0 ± 10.7%. The POSSUM 2 score showed a trend to be higher in patients that died, the mean of the physiological score being 17.7 (20.0 IQ: 13.8 to 24.3 vs. 16.5 IQ: 14 to 20, P = 0.416) and the mean of surgical score being 11.2 (13.0 IQ: 10.5 to 14.3 vs. 10.0 IQ: 9 to 12, P = 0.06), corresponding to a mean of predicted mortality of 7.3% (6.9 IQ: 3.9 to 14.6 vs. 4.0 IQ: 2.6 to 6.4, P = 0.08) and average morbidity of 29.6% (37.0% IQ: 21.9 to 61.8 vs. 21.1% IQ: 14.6 to 34.3, P = 0.06). The mortality rate was 6.57%, generating a standardized mortality rate of 0.47 for the APACHE II score and 0.90 for the POSSUM 2 score.


Our study suggests that the POSSUM 2 score could be a useful tool in predicting mortality in neurosurgical patients admitted to an ICU. It was more accurate to identify the real mortality than the APACHE II score.

Authors’ Affiliations

Centro Universitário Christus - Unichristus, Fortaleza, Brazil
Hospital Universitário Walter Cantídio - UFC, Fortaleza, Brazil
Hospital Geral De Fortaleza - SESA, Fortaleza, Brazil


© Peixoto et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.