Those scores can be applied to assess patient´s evolution of his/her acuity? Or they´re designed to be applied just at admission?
In case of delayed inclusion in a prospective study, severity scores should be recalculated.
In our prospective series on ARF (CCM 1996), we observed that SAPS was higher at the time of inclusion than at admission.In one other prospective study (Pro and anti-inflamatory cytokines during acute pancreatitis, CCM 1996), severity scores were sequentially calculated the days of cytokines follow-up (admission, D1, D3…). Their values decreased within time, but their predictive value remained. An Interesting result, but already known, thus we did not report the results.
Thus, in absence of a prospective series with potential delayed inclusion, SAPS II and APPACHE II, should be computed only during the first 24 h of ICU’s admission; remember 24 H and not a ”calendar” automatic determination as provided by some software..
The two series are available on fulltext in my contribution section.
Why not use the SOFA score that is designed to be measured repeatedly? (http://en.wikipedia.org/wiki/SOFA_score)
May consider the followings:
1. Scores used on ICU admission: patients' severity
2. Scores used at 72-h after ICU: response to treatment
APACHE II is a morbidity score and SAPS II is designed to estimate expected mortality: both scores are designed for patient assessment during the first 24 hours from admission. Apache II and SAPS II were not validated for repeated measures. The only one tool to assess the patient evolution, as previously suggested, is the SOFA score.
Actually I agree with colleague Schwarzkopf. By using the SOFA score changes in patient's severity of illness can be measured
i agree completely with Enrico Lumini answer: SAPS and APACHE II are the 24 first hours golden scores to assess severity and calculated an expected mortality. To asses pateint's evolution SOFA is the gold standard.
Now for a delayed inclusion in a prospective study SAPS and Apache II at admission should computed and perhaps also at inclusion, but... SOFA score at admission and inclusion should be used.
This is an article that you all might find interesting. http://ceaccp.oxfordjournals.org/content/8/5/181.full
I would say scores like the mortality prediction model (MPM) or the sepsis-related organ failure assessment (SOFA) or the multiple organ dysfunction scale (MOFD) would most useful in the longer term ICU patient.
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