Utilizing APACHE II score for early detection of deterioration in neurosurgery ICU: a prospective cohort study.

Abstract

Introduction: This study aimed to evaluate the use of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as a proactive clinical tool to enhance Quality of Care (QoC), providing empirical evidence for critical nursing practice in detecting patient deterioration.

Methods: This prospective cohort study analyzed 76 neurosurgery ICU patients at a tertiary referral hospital. The first 24-hour APACHE II score was calculated to determine its association with clinical deterioration within the first 48 hours. An APACHE II score of ≥16 was established as the cutoff point to stratify patients into high-risk and low-risk groups.

Results: The APACHE II score demonstrated strong prognostic accuracy in predicting mortality (AUC 0.779, p < 0.001). Furthermore, a high-risk APACHE II score (≥16) was significantly associated with the incidence of early clinical deterioration within the first 48 hours (27.3% vs. 4.7%; p = 0.008).

Conclusions: This study provides empirical validation of APACHE II in this neurosurgery cohort, demonstrating good prognostic accuracy. The significant association established between high initial scores and early clinical deterioration suggests its potential utility as an objective trigger for enhanced monitoring. These findings support a shift toward using the score proactively, although validation in larger multi-center cohorts is required.