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Comparison of the APACHE II, MEES and GCS in patients with nontraumatic coma for prediction of mortality


Due to the numerous prehospital descriptive scoring system it is uncertain whether they are efficient in the description of how serious illness are and furthermore whether they can have prognostic role in the estimation of the illness outcome (what is their validity in connection with the prognostic scoring system APACHE II).


In prehospital setting were collected from each patient postintervention values of the MEES and GCS. The APACHE II score were recorded on the day of admission to hospital. This study was undertaken over a 2 year period (January 1996 to October 1998) and included 286 consecutive patients hospitalized for nontraumatic coma. Patients less than 16 years old were not included. There were 168 men and 118 women. Their age varied from 16 to 87 years with a mean 51.8 ± 16.9. Sensitivity, specificity and correct prediction outcome measured by the χ2-method in four severity scores. The Youden Index was also obtained. The best cutoff point in each scoring system was determined by the Youden index. The difference in Youden index was calculated by Z score. A P value <0.05 was chosen to reject the null hypothesis. For each score receiver operating characteristically curve (ROC) were obtained. The difference in ROC was calculated by Z score.


For prediction of mortality, the best cutoff points are 19 for APACHE II; 18 for MEES and 5 for GCS. The Youden index has best cutoff point at 0.63 for APACHE II, 0.61 for MEES and 0.65 for GCS. Correct predictions outcome (%) was for APACHE II 79.9 ± 1.6; for MEES 78.3 ± 1.9 and for GCS 81.9 ± 1.5. The area under ROC is 0.86 ± 0.02 in the APACHE II; 0.8.5 ± 0.06 in the MEES and 0.88 ± 0.03 in the GCS. There was no statistical differences among APACHE II, MEES and GCS in terms of correct prediction outcome. Youden index and the area under ROC (P < 0.05).


APACHE II is not much better than prehospital descriptive scoring system (MEES and GCS). APACHE II and MEES may not replace the role of GCS in the prediction mortality in nontraumatic coma. For the assessment of mortality the GCS score provides the best indicator for these patients (simplicity, less time-consuming and effective information, especially in an emergency situation).

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Grmec, S., Piberl, S. & Gasparovic, V. Comparison of the APACHE II, MEES and GCS in patients with nontraumatic coma for prediction of mortality. Crit Care 3, P250 (2000).

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  • Receiver Operate Characteristically Curve
  • Emergency Situation
  • Prognostic Role
  • Youden Index
  • Illness Outcome