Comparison of two predictive models for prognosis in critically ill patients in a Veteran's Affairs Medical Center coronary care unit

Study objective: The acute physiologic and chronic health evaluation score has been developed to assess prognosis in critically ill patients. Knaus et al initially determined and validated diagnosis-specific coefficients for prediction of outcome in a group of multidisciplinary ICUs. Teskey et al found different coefficients for cardiac diagnoses in a retrospective analysis of coronary care unit (CCU) only patients. This study compares the actual mortality in a Veteran's Affairs Medical Center (VAMC) CCU with the mortality predicted by the two equations. Design and setting: Data were prospectively collected for patients admitted to the medical CCU at a university-affiliated, tertiary care VAMC. Patients: Patients (n=338) admitted to the CCU with the diagnoses of coronary artery disease (CAD), myocardial infarction (MI), congestive heart failure (CHF), arrhythmia (Arr), and other cardiac-related diagnoses. Results: The entire CCU population showed no significant differences from either the predictions by Knaus et al and Teskey et al in 1991. However, when specific disease states were analyzed as a whole, significant differences from both prediction models for CAD and MI actual mortality were found. Teskey et al was a better predictor for the Art and CHF population, while both were equally reliable for other. Conclusions: Either prediction model is reliable for a CCU population in general. However, diagnosis-specific coefficients of Teskey et al appear to correlate better with actual mortality for this VAMC. Significant outcome differences compared with those predicted may reflect the patient population specific to a VAMC.