Specificity and reliability of prognostic indexes in intensive care evaluation: the spontaneous cerebral haemorrhage case.

OBJECTIVE: To determine the reliability of a generic index such as Simplified Acute Physiology Score II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score (ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a general facility that frequently treats a specific type of patients - those with spontaneous cerebral haemorrhage. METHODS: The study cohort consisted of a random sample of patients (81) admitted to Modena's Policlinico Teaching Hospital's ICU with spontaneous ICH over a 24-month period. Main outcome measure SAPSII, ICH score, overall mortality. RESULTS: The mean ICH score for the 32 surviving patients was 3.41 +/- 1.012 while for the 49 deceased patients was of 4.24 +/- 0.855 (P = 0.000). The mean SAPSII value for the 32 surviving patients was 49.09 +/- 16.58 while for the 49 deceased patients was 49.51 +/- 15.93. SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves: the area under the curve was significant for ICH, not-significant for SAPSII. CONCLUSIONS: Regional quality controls use generic prognostic indexes (SAPSII) in relation to mortality and outcome to assess ICUs, which is appropriate when dealing with a general facility when there is not a predominant type of patient, but it may bias the evaluation if the population with specific pathologies (ICH), not included in the general index, is statistically considerable, leading to an incorrect criticality assessment, an inappropriate strategic plan and the subsequent inefficient resource allocation.

Heat wave in Italy and hyperthermia syndrome.

In the city of Modena, Italy, daily temperatures registered during the year 2003 showed a higher mean increase of 3 degrees C compared with the previous three years, with average temperature of 26.1 degrees C, compared with 22.8 degrees C. The reported ambient temperature was higher than 32.3 degrees C in 84% of the recorded days, and daily values exceeded 35.1 degrees C in 62% of the days. During the summer, four heat waves occurred (June 11-15, July 21-23, August 3-15 and August 17-24). Nine patients affected by hyperthermia syndrome with a mean body temperature of 41.4 +/- 1.3 degrees C were admitted to the Intensive Care Unit (ICU) of the Modena Teaching Hospital. Another patient with similar clinical features was not admitted to ICU, but to a general ward, and eventually died a few hours later. Mortality reached 80% and the mean survival time was 4.2 days with median values of one day. All patients except for one were admitted during one of the four above-mentioned heat waves, and in particular, 7 patients were admitted during the period from August 3rd to 15th. A common feature among 8 of the 10 patients was the chronic consumption of psychoactive drugs. According to these observations, it is important to identify a population at risk in case of bioclimatological alarm, to find prevention strategies. It is extremely important in patients with hyperthermia to lower body temperature levels in the early hours to influence the malignant evolution of this severe pathologic process.