외과계 중환자실 환자의 환자분류체계와 APACHE II 점수의 관련성과 사망 예측력 비교 = Relationship between Patient Classification System and APACHE II Scores, and Mortality Prediction in a Surgical Intensive Care Unit

다국어 초록 (Multilingual Abstract)

Purpose: To explore the relationship between nursing care needs and acuity based on the Korean Patient Classification System for Critical Care Nurses (KPCSC) and APACHE II, and to identify their prognostic value in predicting mortality. Methods: A total of 617 patients admitted to a surgical intensive care unit in a tertiary hospital from January 1 to June 30, 2021 were included. The correlation between KPCSC and APACHE II scores, and their predictive power regarding mortality were examined. Results: KPCSC and APACHE II scores showed a significant, positive correlation (r=.32, p<.001). The KPCSC score was significantly correlated with 10 out of 11 KPCSC categories and 2 out of 3 APACHE II domains, whereas the APACHE II score had a significant correlation with all APACHE II domains and only 4 out of 11 KPCSC categories. Both KPCSC and APACHE II demonstrated moderate discriminatory performance in predicting ICU and in-hospital death, and their AUC values were not significantly different. Conclusion: KPCSC, reflecting the severity of illness, predicted mortality as well as APACHE II. However, KPCSC was found to consider factors other than severity, such as patient dependency, which substantiates its value as an assessment tool for nursing care needs.

국문 초록 (Abstract)

연구목적: 중환자실 환자의 중환자분류도구와 APACHE Ⅱ의 관련성을 파악하고, 두 도구의 사망 예측력을 분석하였다. 연구방법: 2021년 1월 1일부터 6월 30일까지 일 상급종합병원 외과계 중환자실 1곳에 입실한 환자 617명을 대상으로 중환자분류도구와 APACHE Ⅱ 점수의 상관관계를 분석하였다. 중환자실 및 병원 내 사망 여부를 조사하여 중환자분류도구 및 APACHE Ⅱ 점수의 사망에 관한 예측력을 비교하였다. 연구결과: 중환자분류도구와 APACHE Ⅱ 점수는 유의한 양의 상관관계를 보였다(r=.32, p<.001). 중환자분류도구는 하위 11개 중 10개, APACHE Ⅱ의 3개 중 2개 영역과 상관관계가 유의하였고, APACHE Ⅱ는 하위의 모든 영역, 중환자분류도구의 11개 중 4개 영역과 상관관계가 유의하였다. 중환자분류도구와 APACHE Ⅱ는 모두 중환자실 및 병원 내 사망에 대해 중등도의 예측력을 보였고, 두 도구의 AUC 차이는 유의하지 않았다. 결론: 중환자분류도구는 간호필요도 평가도구로서 중증도를 반영하여 APACHE Ⅱ만큼 사망을 효과적으로 예측한다. 동시에 중환자분류도구에는 일상생활의존도와 같이 중증도만으로 설명하기 어려운 부분이 존재하므로, 중환자분류도구는 APACHE Ⅱ로 대체할 수 없는 간호필요도 평가도구로서의 가치를 지닌다.

참고문헌 (Reference)

• 1 이한나 ; 손윤정 ; 김혜림 ; 백혜선 ; 박희평, "Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit" 67 (67): 115-122, 2014
• 2 김윤희 ; 이한나 ; 최은영, "Validation of APACHE II score and comparison of the performance of APACHE II and adjusted APACHE II models in a surgical intensive care unit" 26 (26): 232-237, 2011
• 3 Giovannetti P, "Understanding patient classification systems" 9 (9): 4-9, 1979
• 4 Health Insurance Review & Assessment Service (KR), "Third evaluation of the quality of ICU 2019" Health Insurance Review & Assessment Service
• 5 Ceresoli M, "Statistics and research methods for acute care and general surgeons" Springer 2022
• 6 The Shelford Group, "Safer nursing care tool" The Shelford Group
• 7 Health Insurance Review & Assessment Service(KR), "Revision of the notification of the application standards and methods of medical care benefits (Notice No. 2020-186)" Health Insurance Review & Assessment Service
• 8 Takekawa D, "Predict models for prolonged ICU stay using APACHE II, APACHE III and SAPS II scores : A Japanese multicenter retrospective cohort study" 17 (17): e0269737-, 2022
• 9 Mihye Ko ; Miyoung Shim ; Sang-Min Lee ; Yujin Kim ; Soyoung Yoon, "Performance of APACHE IV in medical intensive care unit patients : comparisons with APACHE II, SAPS 3, and MPM(0)III" 33 (33): 216-221, 2018
• 10 Simões JL, "Nursing workload assessment in an intensive care unit : A 5-year retrospective analysis" 30 (30): 528-540, 2021
• 11 McGahan M, "Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : A literature review" 25 (25): 64-77, 2012
• 12 Ghasemi A, "Normality tests for statistical analysis : A guide for non-statisticians" 10 (10): 486-489, 2012
• 13 Kim J, "Measuring patient acuity and nursing care needs in South Korea : Application of a new patient classification system" 21 : 332-, 2022
• 14 McHugh ML, "Measurement issues in patient acuity classification for prediction of hours in nursing care" 16 (16): 20-31, 1992
• 15 PatientCareLink, "Massachusetts hospital data. Staffing plans & reports" Massachusetts Health & Hospital Association
• 16 Capuzzo M, "Hospital mortality of adults admitted to intensive care units in hospitals with and without intermediate care units : a multicentre European cohort study" 18 (18): 551-, 2014
• 17 박영선 ; 송라윤, "Estimation of nurse staffing based on nursing workload with reference to a patient classification system for a intensive care unit" 10 (10): 1-12, 2017
• 18 Crossfield CL, "Enteral nutrition feeding practices by intensive care nurses : A retrospective evaluation" 27 (27): 676-681, 2022
• 19 Ministry of Health and Welfare (KR), "Enforcement rules of the medical service act. Ordinance of the Ministry of Health and Welfare No. 966" Ministry of Health and Welfare
• 20 유정숙 ; 심미영 ; 최은하, "Development of Korean Patient Classification System for Critical Care Nurses" 21 (21): 401-411, 2015
• 21 송경자 ; 김은혜 ; 유정숙 ; 박혜옥 ; 박광옥, "Development of KPCS(Korean Patient Classification System for Nurses)based on nursing needs" 15 (15): 5-17, 2009
• 22 Smith S, "Developing, testing and applying instruments for measuring rising dependency-acuity's impact on ward staffing and quality" 22 (22): 30-39, 2009
• 23 조성현 ; 이지윤 ; 홍경진 ; 윤효정 ; 심원희 ; 김문숙 ; 허익수, "Determining nurse staffing by classifying patients based on their nursing care needs" 26 (26): 42-54, 2020
• 24 Department of Health (UK), "Comprehensive critical care: A review of adult critical care services" Department of Health
• 25 DeLong ER, "Comparing the areas under two or more correlated receiver operating characteristic curves : A nonparametric approach" 44 (44): 837-845, 1988
• 26 Zimmerman JE, "Acute Physiology and Chronic Health Evaluation(APACHE)IV : hospital mortality assessment for today's critically ill patients" 34 (34): 1297-1310, 2006
• 27 Knaus WA, "APACHE-acute physiology and chronic health evaluation : A physiologically based classification system" 9 (9): 591-597, 1981
• 28 Naved SA, "APACHE-II score correlation with mortality and length of stay in an intensive care unit" 21 (21): 4-8, 2011
• 29 Knaus WA, "APACHE II : A severity of disease classification system" 13 (13): 818-829, 1985
• 30 American Nurses Association, "ANA's principles for nurse staffing" 2020