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APACHE Scoring table: Difference between revisions

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The calculation of the store happens automatically and data collectors do not need to fit patient scores into this ranking or perform calculations.  
The calculation of the store happens automatically and data collectors do not need to fit patient scores into this ranking or perform calculations.  


== Chemistry Values==
== Physiological Variables ==
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
MAX score = 48
|- style="background-color:#CCCCE6;font-weight:bold" align="center" valign="top"
{{#ask: [[Category:APACHE II Physiological Variables]]
| width="125" height="16" | Points
| ?AP phys name
| width="48" | 4
| ?AP phys unit
| width="48" | 3
| ?AP phys absMax
| width="48" | 2
| ?AP phys warnMax
| width="48" | 1
| ?AP H4
| width="48" | 0
| ?AP H3
| width="48" | 1
| ?AP H2
| width="48" | 2
| ?AP H1
| width="48" | 3
| ?AP 0
| width="48" | 4
| ?AP L1
| ?AP L2
| ?AP L3
| ?AP L4
| ?AP phys warnMin
| ?AP phys absMin
|sort=AP phys name
|order=ascending
|format=broadtable
|default=Problem with SMW ask call
|headers=show
|class=sortable wikitable smwtable
}}


|-  align="center" valign="top"
== definitions ==
|style="background-color:#CCCCE6" rowspan="2" height="15" | [[Temperature]]
A lot of these values follow very specific definitions and collection instructions. See individual linked articles for details. Especially, see
| rowspan="2" | ≥41
* [[Mean BP]]
| rowspan="2" | 39-40.9
* [[Arterial blood gas (APACHE)]]
| rowspan="2" | &nbsp;
* [[Glasgow Coma Scale]]
| rowspan="2" | 38.5-38.9
|style="background-color:#CCCCE6" rowspan="2" | 36-38.4
| rowspan="2" | 34-35.9
| rowspan="2" | 32-33.9
| rowspan="2" | 30-31.9
| ≤


|-  align="center" valign="top"
=== number of decimal points in definitions ===
| 29.9
Some values arrive with a higher decimal precision than the definitions. Since the definitions have holes, that would lead to values in the holes being undefined for points.
This is solved by rounding the value to one decimal point and applying the score to that.


|-  align="center" valign="top"
=== [[Glasgow Coma Scale]] (GCS) ===
|style="background-color:#CCCCE6" height="16" | [[mean BP]]
For information on collecting and coding the values, see the [[Glasgow Coma Scale]] article.
| ≥160
*GCS = EYE point + MOTOR point + VERBAL point
| 130-159
*Neurological Points = 15 - GCS
| 110-129
=== Acute Physiologic Score (APS) ===
| &nbsp;
APS = [[#Physiological_Variables]] points + Neurological points from GCS
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 50-69
| &nbsp;
| ≤49


|-  align="center" valign="top"
==== Inclusion of pH in absence of other ABG components ====
|style="background-color:#CCCCE6" height="16" | [[HR]]
include it
| ≥180
| 140-179
| 110-139
| &nbsp;
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 55-69
| 40-54
| ≤39


|-  align="center" valign="top"
== [[Age]] Points ==
|style="background-color:#CCCCE6" height="16" | [[RR]]
| ≥50
| 35-49
| &nbsp;
| 25-34
|style="background-color:#CCCCE6" | 12-24
| 10-11
| 6-9
|
| ≤5
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | AaDO2 (if [[FiO2|FiO<sub>2</sub>]] >= 50%)
| ≥500
| 350-499
| 201-349
| &nbsp;
|style="background-color:#CCCCE6" | 200
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[PO<sub>2</sub>]] (if [[FiO2|FiO<sub>2</sub>]] < 50%)
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|style="background-color:#CCCCE6" | 70
| 61-69
| &nbsp;
| 55-60
| ≤54
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Arterial pH]]
| ≥7.7
| 7.6-7.69
| &nbsp;
| 7.5-7.59
|style="background-color:#CCCCE6" | 7.33-7.49
| &nbsp;
| 7.25-7.32
| 7.15-7.24
| ≤ 7.14
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Serum CO2]] (If no ABG)
| ≥52
| 41-51.9
| &nbsp;
| 32-40.9
|style="background-color:#CCCCE6" | 22-31.9
| &nbsp;
| 18-21.9
| 15-17.9
| ≤14
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Na]]
| ≥180
| 160-179
| 155-159
| 150-154
|style="background-color:#CCCCE6" | 130-149
| &nbsp;
| 120-129
| 111-119
| ≤110
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[K +]]
| ≥7
| 6-6.9
| &nbsp;
| 5.5-5.9
|style="background-color:#CCCCE6" | 3.5-5.4
| 3-3.4
| 2.5-2.9
| &nbsp;
| ≤2.4
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="26" | [[Creatinine]] (*Double point if yes for  [[ARF field|ARF]])
| ≥309
| 178-308
| 133-177
| &nbsp;
|style="background-color:#CCCCE6" | 53-132
| &nbsp;
| 52
| &nbsp;
| &nbsp;
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[HCT]]
| ≥60
| &nbsp;
| 50-59.9
| 46-49.9
|style="background-color:#CCCCE6" | 30-45.9
| &nbsp;
| 20-29.9
| &nbsp;
| ≤19
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[WBC]]
| ≥40
| &nbsp;
| 20-39.9
| 15-19.9
|style="background-color:#CCCCE6" | 3-14.9
| &nbsp;
| 1-2.9
| &nbsp;
| <1
|}
 
== Glasgow Coma Scale ==
For information on collecting and coding the values, see the [[Glasgow Coma Scale]] article.
 
A Glasgow Coma Scale score of 15 would be considered "Total Neuro Points".
 
The Glasgow Coma Scale is scored in APACHE II as follows:
 
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
|- style="background-color:#CCCCE6;font-weight:bold" align="center" valign="top"
| width="125" height="16" align="right"| Points
| width="64" | 6
| width="58" | 5
| width="48" | 4
| width="48" | 3
| width="48" | 2
| width="48" | 1
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="27" | '''Eyes'''
| &nbsp;
| &nbsp;
| Spontaneous
| To Speech
| To Pain
| None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="39" | '''Motor'''
| Obeys Command
| Localizes Pain
| Withdraws to Pain
| Abnormal Flexion
| Abnormal Extension
| None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="38" | '''Verbal'''
| &nbsp;
| Oriented
| Confused
| Inappropriate words
| Incomprehensive sounds
| None
 
|}
 
 
 
== Age Points ==
The age of the patient is automatically generated from the [[DOB field|date of birth]] and the date of admission when collecting data.  
The age of the patient is automatically generated from the [[DOB field|date of birth]] and the date of admission when collecting data.  


{| class="wikitable" border=1  
{| class="wikitable" border=1  
|- style="background-color:#CCCCE6;font-weight:bold" valign="top" align="center"  
|- style="background-color:#CCCCE6;font-weight:bold"  
| width="58" height="16" | Age
|| Age
| width="48" | ≤44
|| ≤44
| width="48" | 45-54
|| 45-54
| width="48" | 55-64
|| 55-64
| width="48" | 65-74
|| 65-74
| width="48" | ≥75
|| ≥75


|- align="center" valign="top"
|-
|style="font-weight:bold" height="16" | Points
|style="font-weight:bold" | Points (agepts)
  | 0
  | 0
  | 2
  | 2
Line 246: Line 70:


|}
|}
=== before de-stubbing ===
* confirm if age calculated from admission date
== Chronic Health ==
We pull some of the values for the chronic health score from the coded diagnoses and some from ...
The [[Chronic health field]] is scored as follows:
{| class="wikitable" border=1
|- style="background-color:#CCCCE6;font-weight:bold" valign="top"
| width="75" height="40" | Points
|style="font-weight:bold" width="75" | 0
|style="font-weight:bold" width="100" | 2
|style="font-weight:bold" width="150" | 5
|- valign="top"
|style="background-color:#CCCCE6" height="52" | Chronic Health  Status
| No history of chronic disease
| Elective Post op with history of chronic disease
| Non OP (medical) or emergency post op with history of chronic disease
|}
Chronic Disease can be one of the following:
{| class="wikitable" border=1
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" width="153" height="32" | Liver
| width="284" |
'''any''' of
* biopsy proven cirrhosis & documented portal hypertension
* past episodes of GI bleeds, hepatic failure encephalopathy, coma


|-  valign="top"
== Chronic Health Score ==
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Cardiovascular
The chronic health score is calculated from [[Chronic Health APACHE]] and [[Admit Type for APACHE II]] as follows:
| Class 4 Angina  - pain @ rest or with minimal extertion


|- valign="top"
=== Correct scoring for Apache II Chronic Health ===
|style="background-color:#CCCCE6;font-weight:bold" height="51" | Respiratory
: If admit type is: "Medical (non operative)" or "Emergency Surgery" PLUS one or more [[Chronic Health APACHE]] is present:
|
:: Score = 5
'''any''' of
: If "elective surgery" PLUS one or more [[Chronic Health APACHE]]is present:
* COPD
::Score = 2
* Restrictive lung disease
:if [[Chronic Health APACHE]] is "none" then
* Vascular disease resulting in severe exercise restriction
:: Score = 0
* documented Hypoxia, hypercapnia, polycythemia 
* Pulmonary HTN
* on home O2
* Ventilator dependent


|-  valign="top"
==Total Apache Score==
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Renal
TotApache = APS + Chronic Health points+ agepts
| Receiving Chronic Dialysis


|-  valign="top"
TotApache MAX =74
|style="background-color:#CCCCE6;font-weight:bold" height="64" | Immuno-compromised
| Receiving therapy that suppresses resistance to infection such as
* Chemo
* Radiation
* ≥10 mg prednisone
* ≥15mg/kg/day hydrocortisone
* >3 mg/kg’day of methyoprednisolone for >5 days
or sufficiently advanced disease to suppress resistance to infection
* Leukemia
* lymphoma Aids
* metastatic cancer
|}


== Related articles ==
{{Related Articles}}


=== to do before de-stubbing ===
* where do we pull the chronic data from?
* if we have chronic field (I seem to remember) we should list all its info separately and only give the scoring algorithm here.




{{stub}}
[[Category:APACHE II | *]]
[[Category:APACHE II]]
[[Category:APACHE II Physiological Variables | *]]
[[Category:ABG]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=APACHE_Scoring_table"