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Objective: As hormones are strongly associated with mortality in critically ill patients, we investigated whether mortality prediction based on the Acute Physiology and Chronic Health Evaluation (APACHE) is improved by [...]

Byline: DaniA< Keywords: Data quality Medical registries Evaluative research Intensive care APACHE II SAPS II Abstract: To analyse the quality of data used to measure severity of illness in the Dutch National Intensive Care Evaluation (NICE) registry, after implementation of quality improving procedures. Design. Data were re-abstracted from the paper records of patients or the Patient Data Management System and compared to the data contained in the registry. The re-abstracted data were considered to be the gold standard. Setting. ICUs of nine Dutch hospitals that had been collecting data for the NICE registry for at least 1 year. Measurement and results. The mean percentages of inaccurate and incomplete data, per hospital, over all variables, were 6.1%+-4.4 (SD) and 2.7%+-4.4 (SD), respectively. The mean difference in severity of illness scores between registry data and re-abstracted data was 0.2 points for APACHE II and 0.4 points for SAPS II. The mean difference in predicted mortality according to APACHE II and SAPS II between registry data and re-abstracted data was 0.4% and 0.02%, respectively. Conclusions. The current data quality of the NICE registry is good and justifies evaluative research. These positive results might be explained by the implementation of several quality assurance procedures in the NICE registry, such as training and automatic data checks. Electronic supplementary material to this paper can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00134-002-1272-z Author Affiliation: (1) Department of Medical Informatics and Department of Intensive Care, Academic Medical Center, P.O.Box 22700, 1100 DE Amsterdam, The Netherlands (2) Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands (3) Department of Anesthesia and Intensive Care, Anphia Hospital, Breda, The Netherlands (4) Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands Article History: Received Date: 18/07/2001 Accepted Date: 21/02/2002 Article note: Electronic Publication

Byline: Carl G. Backman (1), Sten M. Walther (1) Keywords: Critically ill Intensive care Diary Post-traumatic stress disorder Memory Psychological recovery Abstract: Objective: To explore the use of a diary as an aid in debriefing patients and relatives following critical illness. Design: Observation study. Setting: Intensive care unit of a 500-bed hospital. Patients and participants: Fifty-one critically ill patients and their relatives. Method: A daily account of the patient's progress was written in everyday language by nursing staff, photographs were added as necessary. The booklet was given to the patient or a relative at a follow-up appointment 2 weeks after discharge from the unit. A standard questionnaire was mailed 6 months later, responses were analyzed by an independent observer. Measurements and results: All diaries had been read by survivors (n=41) or relatives (n=10), 51% of the diaries had been read more than 10 times. Comments in the questionnaires were graded as very positive (39%), positive (28%) and neutral (33%). Conclusions: A detailed narrative of the patient's stay is a useful tool in the debriefing process following intensive care. Author Affiliation: (1) Intensive Care Unit, Department of Anaesthesia and Intensive Care, Vrinnevisjukhuset, Norrkoping, Sweden Article History: Received Date: 15/04/2000 Accepted Date: 01/09/2000 Article note: Electronic Publication

Byline: J. F. Bion (1) Keywords: Key words Critical illness; Intensive care; Severity of illness; Scoring systems; Genetics; Susceptibility; Education Abstract: Risk of critical illness is determined both by genetic and environmental influences, particularly those relating to infectious and cardiovascular diseases. Physiologically-based scoring systems cannot measure prior risk because they do not quantify physiological reserve independently of the acute illness. Genetic profiling could be useful for risk assessment. Early detection of critical illness involves identifying physiological 'triggers' for referral this requires the education of nursing and medical staff in their significance. Analysis of the relationship between risk factors and interventions may need complex modelling techniques. Therapeutic strategies depend on the nature of the underlying problem: the most useful are likely to be those which enhance tissue oxygen delivery and resistance to infection. Author Affiliation: (1) Birmingham University, N5 Queen Elizabeth Hospital, Birmingham B15 2TH, UK e-mail: J. F. Bion@bham.ac.uk, GB