APACHE physiological variable collection: Difference between revisions

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== Guidelines for the Values to use for APACHE II Physiologic Variables ==

=== Use the worst ===

*The general rule is to use the '''worst value as per APACHE II rules''' in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, i.e. first [[Service tmp entry]] DtTm.

=== When not available ===

The following info is relevant if no measurements were taken or in cases of [[Lost/missing chart]].

*You can not enter 0 for any of these, and you can't leave them blank.

*The general rule is to use the WORST value in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, not when he/she arrives in the ICU)

*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the profile, you can go back ''prior'' to the start of the ICU record, and use the value closest to the start time of the ICU record (but max 24 hrs prior to admission).

**What we mean by "worst" is as per APACHE II rules

**If there are no values for that parameter either during the first 24 hours OR up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.

*If for a given parameter there are NO values during that initial 24 hours, go back prior to the start of the ICU record, and use the value closest to the start time of the ICU record (max 24 hrs prior to admission).

**If there are no values for that parameter either during or up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.

=== Values during Arrest ===

*In regards to values that occurred or measured during ~~cardiopulmonary arrests:~~

*'''DO NOT''' use vital signs from arrests. Instead use the worst values from recordings '''OTHER THAN the code sheet'''.

**'''DO NOT''' use vital signs from arrests

*You can use labs drawn during arrests, but only do so if these are the ONLY labs available.

**You can use labs drawn during arrests, but only do so if these are the ONLY labs available.

**For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.

*For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.

*The rationale is that codes are specific, usually short interludes and if it occurs we don't miss it as there should be the ICD10 diagnosis listed for it ([[Cardiac arrest]]).

== Iatrogenically changed values ==

*Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.

*However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see [[Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests]]).

== Related articles ==

@@ Line 10: / Line 10: @@
 == Guidelines for the Values to use for APACHE II Physiologic Variables ==
+=== Use the worst ===
+*The general rule is to use the '''worst value as per APACHE II rules''' in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, i.e. first [[Service tmp entry]] DtTm.
+=== When not available ===
+The following info is relevant if no measurements were taken or in cases of [[Lost/missing chart]].
 *You can not enter 0 for any of these, and you can't leave them blank.
-*The general rule is to use the WORST value in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, not when he/she arrives in the ICU)
+*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the profile, you can go back ''prior'' to the start of the ICU record, and use the value closest to the start time of the ICU record (but max 24 hrs prior to admission).
-**What we mean by "worst" is as per APACHE II rules
+**If there are no values for that parameter either during the first 24 hours OR up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.
-*If for a given parameter there are NO values during that initial 24 hours, go back prior to the start of the ICU record, and use the value closest to the start time of the ICU record (max 24 hrs prior to admission).
-**If there are no values for that parameter either during or up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.
+=== Values during Arrest ===
-*In regards to values that occurred or measured during cardiopulmonary arrests:
+*'''DO NOT''' use vital signs from arrests.  Instead use the worst values from recordings '''OTHER THAN the code sheet'''.
-**'''DO NOT''' use vital signs from arrests
+*You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
-**You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
+**For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
-*For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
+*The rationale is that codes are specific, usually short interludes and if it occurs we don't miss it as there should be the ICD10 diagnosis listed for it ([[Cardiac arrest]]).
+== Iatrogenically changed values ==
+*Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
+*However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see [[Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests]]).
 == Related articles ==