• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1983 August; 73(8): 878–884.
PMCID: PMC1651115

Statistical validation of a severity of illness measure.


This paper provides statistical detail on the predictive power of a new severity of illness scale--APACHE (Acute Physiology and Chronic Health Evaluation)--on 833 consecutive medical admissions to an intensive care unit (ICU). In a multivariate logistic regression analysis of routine physiologic and other data obtained within 24 hours of ICU admission, severity of illness and age were significantly (p less than .0001) related to survival. Using the estimated equation to forecast death rates for independent data, APACHE allowed accurate estimates of death rates for groups of patients whose mortality at hospital discharge varied from 3 to 80 per cent. The Acute Physiology Score of APACHE is also strongly and significantly associated with outcome within a number of specific cardiovascular, neurologic, respiratory, and gastrointestinal diagnoses. After multi-institutional validation studies, APACHE could prove useful in a wide range of studies involving acutely ill patients.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Freiman JA, Chalmers TC, Smith H, Jr, Kuebler RR. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 "negative" trials. N Engl J Med. 1978 Sep 28;299(13):690–694. [PubMed]
  • Horwitz RI, Feinstein AR. Improved observational method for studying therapeutic efficacy. Suggestive evidence that lidocaine prophylaxis prevents death in acute myocardial infarction. JAMA. 1981 Nov 27;246(21):2455–2459. [PubMed]
  • Norris RM, Brandt PW, Caughey DE, Lee AJ, Scott PJ. A new coronary prognostic index. Lancet. 1969 Feb 8;1(7589):274–278. [PubMed]
  • Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480–484. [PubMed]
  • Feller I, Tholen D, Cornell RG. Improvements in burn care, 1965 to 1979. JAMA. 1980 Nov 7;244(18):2074–2078. [PubMed]
  • Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981 Aug;9(8):591–597. [PubMed]
  • Cullen DJ, Ferrara LC, Briggs BA, Walker PF, Gilbert J. Survival, hospitalization charges and follow-up results in critically ill patients. N Engl J Med. 1976 Apr 29;294(18):982–987. [PubMed]
  • Truett J, Cornfield J, Kannel W. A multivariate analysis of the risk of coronary heart disease in Framingham. J Chronic Dis. 1967 Jul;20(7):511–524. [PubMed]
  • Chambers EA, Cox DR. Discrimination between alternative binary response models. Biometrika. 1967 Dec;54(3):573–578. [PubMed]
  • Detsky AS, Stricker SC, Mulley AG, Thibault GE. Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit. N Engl J Med. 1981 Sep 17;305(12):667–672. [PubMed]
  • McNeil BJ, Keller E, Adelstein SJ. Primer on certain elements of medical decision making. N Engl J Med. 1975 Jul 31;293(5):211–215. [PubMed]
  • Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980 Jul 17;303(3):130–135. [PubMed]
  • Shoemaker WC, Appel PL, Bland R, Hopkins JA, Chang P. Clinical trial of an algorithm for outcome prediction in acute circulatory failure. Crit Care Med. 1982 Jun;10(6):390–397. [PubMed]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE, Birnbaum ML, Cullen DJ, Kohles MK, Shin B, Snyder JV. Evaluating outcome from intensive care: a preliminary multihospital comparison. Crit Care Med. 1982 Aug;10(8):491–496. [PubMed]
  • Knaus WA, Le Gall JR, Wagner DP, Draper EA, Loirat P, Campos RA, Cullen DJ, Kohles MK, Glaser P, Granthil C, et al. A comparison of intensive care in the U.S.A. and France. Lancet. 1982 Sep 18;2(8299):642–646. [PubMed]
  • Horn SD. Measuring severity of illness: comparisons across institutions. Am J Public Health. 1983 Jan;73(1):25–31. [PMC free article] [PubMed]
  • Scheffler RM, Knaus WA, Wagner DP, Zimmerman JE. Severity of illness and the relationship between intensive care and survival. Am J Public Health. 1982 May;72(5):449–454. [PMC free article] [PubMed]
  • Mosteller Frederick. Improving the Precision of Clinical Trials. Am J Public Health. 1982 May;72(5):430–430. [PMC free article]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...