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== When to collect, which value to use ==
== When to collect, which value to use ==
The Higher the APACHE score, the sicker the patient.
See [[Selection and timing of APACHE components]]


Select the physiological values that reflect the '''worst''' deviation from normal in the '''first 24 hours''' while "in" the ICU. The clock starts at the '''[[Arrive DtTm ]]'''. If the length of stay in ICU is less than 24, use those values only.
=== Exceptionally high or low values ===
[[CCMDB.accdb]] has error checks for values that are ''unlikely'' high or low to prevent errors. The ranges were determined by the [[statistician]] based on previous data(see abs min and abs max in [[APACHE_Scoring_table]]). To keep the checks meaningful the threshold values will not be changed for extreme outliers.


The ''Worst'' value could be '''high''' or '''low''', depending which gives the most [[APACHE Scoring table#Chemistry_values| points]].
For values outside the '''"warning" limit''', you must '''enter the reason''' for this into the [[Notes field]] so that we can validate that these were not errors. <!-- as of [[CCMDB.mdb_Change_Log_2011#ver_2011-05-04]] -->
Keep in mind the diagnosis and try not to include iatrogenically enhanced symptoms, e.g. BP severely high due to inotropes or decreased LOC due to sedation.


== Missing Values Rule for APACHE II ==
For values outside the '''"absolut" limit''', enter the '''closest value allowed''' and enter a comment into the [[Notes field]]. Also, '''email Pagasa the correct value'''.
You can not enter 0 for APACHE physiological variables, and you can't leave them blank.  


== Patient lived ==
== Guidelines for the Values to use for APACHE II Physiologic Variables ==
If a specific physiological variable is '''not''' available during the first 24 hours when admitted to ICU then select a value closest to the time '''prior to''' admission to the unit, (max 24 hrs prior to admission). Make a note in your [[Notes field]] and record date time and location this variable was obtained from (e.g. ER or ward).  
=== 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.  


If no information is available, then assume it was not tested because it was normal. Record the midpoint of the normal range for this value, which will generate a normal APACHE score for this item. The midpoint of each normal range can be found by double-clicking on the Apache score for the field in CCMDB.mdb.
=== 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.
*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).  
**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.


=== Use of pre-admission ER LAB results ===
=== Values during Arrest ===
{{discussion}}
*'''DO NOT''' use vital signs from arrests.  Instead use the worst values from recordings '''OTHER THAN the code sheet'''.
'''The following refers to an ongoing discussion, not to a change in collection rules:'''
*You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
As discussed in the [[:Category:Critical Care Review Group|Critical Care Review Group]], the last 4 hours in the ER/OR/ward preceding admission to the ICU may be admissible data for APACHE values ''only if'' there is no data is available for the first 24 hours ''in'' ICU. Is this a rule we are using? [[User:Ttenbergen|Ttenbergen]] 13:12, 17 October 2008 (CDT)
**For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
* The above seems to be in conflict with the missing value rule below. Is it 4 or 24 hrs prior to admission? Is this really limited to values from the ER?[[User:Ttenbergen|Ttenbergen]] 15:38, 2 May 2011 (CDT)[[User:Ttenbergen|Ttenbergen]] 19:00, 2012 September 6 (CDT)
*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]]).
** anyone? Ttenbergen 14:12, 2014 September 19 (CDT)


== Patient DIED shortly after arriving in unit ==
== Iatrogenically changed values ==
We don't want values of dead people.
*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.
For patients who died in the unit and have '''no''' data available to record for any one of the physiological variables during their stay on the unit:
*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]]).
 
1. Select the value that is '''closest''' to the time "prior to" unit admission such as ER or ward.
 
2. If the above is NOT an option then the following applies:
 
'''A.''' For the following vital signs elements-select the '''lowest limit value''' on the APACHE score table that will give you the highest score.
*This applies to the following fields:
** [[HR]] - (Heart Rate)
** [[BP]] - (Blood Pressure)
** [[RR]] - (Respiratory Rate)
 
'''B.''' For other APACHE elements-record '''NORMAL values'''. Normal values are those items that give you a zero APACHE II point.
*This applied to the following fields:
**[[Temperature]]
**[[Serum CO2]] - use 25
**[[Na]] -(Sodium)
**[[K]] -(Potassium)
**[[CREAT]] -(Creatinine)
**[[HCT]] -(Hematocrit)
**[[WBC]] -(White Blood Count)


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


[[Category:APACHE II]]
[[Category:APACHE II]]
[[Category:End-of-life related data]]
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