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Severity Stratification in Life-threatening Asthma

ICU Research Unit, Department of Anesthesiology and Computer Medicine, The George Washington University Medical Center, Washington, DC

Leslie H. Galler

Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand

James A. Judson

Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand

Stephen J. Streat

Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand

Ronald V. Trubuhovich

Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand

Severity differences may in part explain the large varia tions in asthma mortality that occur in different coun tries. This study examines the use of APACHE II for measuring asthma severity in 118 adult asthma admis sions at one intensive care unit in New Zealand during 1987-1988. Most admissions were hypercapnic (72%), and 61 % had an altered level of consciousness. Mean APACHE II score was 20 in the emergency department and 12 upon ICU admission. We summarize the extent of physiological derangement using four acute physiol ogy score (APS) ranges. Each APS range stratified admis sions into groups with differing clinical course, therapy, and outcome. These results document a high level of asthma severity among patients treated in New Zealand, the country with the world's highest asthma mortality. APACHE II provides a valid and reproducible measure of asthma severity and should be useful for describing and comparing international differences in asthma severity and as a case-mix control in studies of asthma therapy.

Journal of Intensive Care Medicine, Vol. 5, No. 3, 120-127 (1990)
DOI: 10.1177/088506669000500305


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