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American Journal of Critical Care. 2007;16: 378-383
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Interrater Reliability of APACHE II Scores for Medical-Surgical Intensive Care Patients: A Prospective Blinded Study

By Michelle E. Kho, BHSc(PT), MSc, Ellen McDonald, RN, Paul W. Stratford, PT, MSc and Deborah J. Cook, MD, MSc, FRCPC. Michelle E. Kho is a registered physical therapist and a PhD candidate in the Clinical Health Sciences, Health Research Methodology Program, at McMaster University, Hamilton, Ontario, Canada. Ellen McDonald is a critical care research coordinator at St Joseph’s Health-care, a teaching center for McMaster University. Paul W. Stratford is a professor of physiotherapy in the School of Rehabilitation Sciences and an associate member of the Department of Clinical Epidemiology and Biostatistics at McMaster University. Deborah J. Cook is a practicing intensivist, clinical trialist, and professor of medicine and clinical epidemiology and biostatistics at McMaster University.

Corresponding author: Michelle E. Kho, BHSc(PT), MSc, Program in Evidence-Based Care, Cancer Care Ontario, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4L8 (e-mail: khome{at}mcmaster.ca).

Background Despite widespread use of the Acute Physiology and Chronic Health Evaluation II (APACHE II), its interrater reliability has not been well studied.

Objective To determine interrater reliability of APACHE II scores among 1 intensive care nurse and 2 research clerks.

Methods In a prospective, blinded, observational study, 3 raters collected APACHE II scores on 37 consecutive patients in a medical-surgical intensive care unit. One research clerk was blinded to the study’s start date to minimize observer bias. The nurse and the other research clerk were blinded to each other’s scores and did not communicate with the first research clerk about the study. The data analyst was blinded to the identity and source of all 3 raters’ scores. Intraclass correlation coefficients and 95% confidence intervals were assessed.

Results Mean (standard deviation) APACHE II scores were 21.8 (9.2) for the nurse, 20.4 (7.7) for research clerk 1, and 20.5 (8.1) for research clerk 2. Among the 3 raters, the intraclass correlation coefficient (95% confidence interval) was 0.90 (0.84, 0.94) for the APACHE II total score. Within APACHE II score components, the highest reliability was for age (0.98 [0.97, 0.99]), with lower reliabilities for the Chronic Health Index (0.64 [0.50, 0.80]) and the verbal component of the Glasgow Coma Scale (0.40 [0.20, 0.60]). Results were similar between pairs of raters.

Conclusions Use of trained nonmedical personnel to collect illness severity scores for clinical, research, and administrative purposes is reasonable. This method could be used to assess reliability of other illness severity scores.






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