Reliability and accuracy of practitioner-calculated Acute Physiology and Chronic Health Evaluation II scores for determining the appropriateness of drotrecogin alfa (activated)
PURPOSE: The reliability and accuracy of practitioner-calculated Acute Physiology and Chronic Health Evaluation (APACHE) II scores for determining the appropriateness of drotrecogin alfa (activated) in critically ill patients were evaluated. METHODS: Three adjudicated clinical cases of sepsis were d...
| Publicado en: | American Journal of Health-System Pharmacy Vol. 67; no. 2; pp. 136 - 144 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
1/15/2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105293899&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105293899 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10792082 1X3 jtl: American Journal of Health-System Pharmacy issn: 10792082 maglogo: N pubinfo: dt: 1/15/2010 vid: 67 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 105293899 105293899 2010534352 10.2146/ajhp090186 NLM20065268 105293899 ppf: 136 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Reliability and accuracy of practitioner-calculated Acute Physiology and Chronic Health Evaluation II scores for determining the appropriateness of drotrecogin alfa (activated) aug: au: Owen PS Tan EC Kiser TH Fish DN MacLaren R affil: Department of Pharmacy Practice, College of Pharmacy and Health Sciences Center, Mercer University (MU), Atlanta, GA sug: subj: Decision Making, Clinical Recombinant Proteins Therapeutic Use Sepsis Drug Therapy Academic Medical Centers APACHE (Acute Physiology and Chronic Health Evaluation) Case Studies Chi Square Test Clinical Assessment Tools Colorado Data Analysis Software Descriptive Statistics Fisher's Exact Test Glasgow Coma Scale Human Interrater Reliability Intrarater Reliability kappa Statistic Nonexperimental Studies Physicians Scales Validity Wilcoxon Rank Sum Test Yates' Continuity Correction ab: PURPOSE: The reliability and accuracy of practitioner-calculated Acute Physiology and Chronic Health Evaluation (APACHE) II scores for determining the appropriateness of drotrecogin alfa (activated) in critically ill patients were evaluated. METHODS: Three adjudicated clinical cases of sepsis were developed using composites of real patient scenarios. The patients' APACHE II scores were independently assessed by randomly selected critical care practitioners (physicians and nonphysicians). Each case contained at least one reason to consider withholding drotrecogin alfa (activated), but none had a definitive contraindication to drotrecogin alfa (activated). Intraobserver and interobserver variabilities were assessed using kappa correlation. Accuracy was assessed by comparing median scores to the adjudicated scores and evaluating correctly classified APACHE II scores. RESULTS: A total of 21 (42%) physicians and 14 (56%) nonphysicians completed all assessments. Intraobserver and interobserver variabilities were 0.16 and 0.49 for the total APACHE II score, respectively. Median calculated APACHE II scores significantly differed for case 1 (p = 0.003) and case 3 (p < 0.0001). The percentage of error in calculating the total APACHE II score approached 85%. The main reasons for administering drotrecogin alfa (activated) were an APACHE II score of >or=25 and multiple organ failures. The main reason for therapy was a high bleeding risk or an APACHE II score of <25. CONCLUSION: Weak intraobserver agreement, modest interobserver reliability, a high error rate, and low accuracy limited the clinical application of the APACHE II score by untrained practitioners, indicating that the APACHE II score should not be the only determinant for the use of drotrecogin alfa (activated). pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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