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APACHE Scoring table: Difference between revisions

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The '''Scoring table''' for [[:category:APACHE II|APACHE II]] describes how various fields we collect affect the ultimate APACHE II score. The score itself is automatically calculated, no manual addition needs to be performed.  
The '''Scoring table''' for [[:category:APACHE II|APACHE II]] describes how various fields we collect affect the ultimate APACHE II score.  


== Chemistry Values==
The calculation of the store happens automatically and data collectors do not need to fit patient scores into this ranking or perform calculations.
{| 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" | Points
| width="48" | 4
| width="48" | 3
| width="48" | 2
| width="48" | 1
| width="48" | 0
| width="48" | 1
| width="48" | 2
| width="48" | 3
| width="48" | 4


|-  align="center" valign="top"
== Physiological Variables ==
|style="background-color:#CCCCE6" rowspan="2" height="15" | [[Temperature]]
MAX score = 48
| rowspan="2" | ≥41
{{#ask: [[Category:APACHE II Physiological Variables]]  
| rowspan="2" | 39-40.9
| ?AP phys name
| rowspan="2" | &nbsp;
| ?AP phys unit
| rowspan="2" | 38.5-38.9
| ?AP phys absMax
|style="background-color:#CCCCE6" rowspan="2" | 36-38.4
| ?AP phys warnMax
| rowspan="2" | 34-35.9
| ?AP H4
| rowspan="2" | 32-33.9
| ?AP H3
| rowspan="2" | 30-31.9
| ?AP H2
| ≤
| ?AP H1
| ?AP 0
| ?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 ==
| 29.9
A lot of these values follow very specific definitions and collection instructions. See individual linked articles for details. Especially, see
* [[Mean BP]]
* [[Arterial blood gas (APACHE)]]
* [[Glasgow Coma Scale]]


|-  align="center" valign="top"
=== number of decimal points in definitions ===
|style="background-color:#CCCCE6" height="16" | [[mean BP]]
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.
| ≥160
This is solved by rounding the value to one decimal point and applying the score to that.
| 130-159
| 110-129
| &nbsp;
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 50-69
| &nbsp;
| ≤49


|-  align="center" valign="top"
=== [[Glasgow Coma Scale]] (GCS) ===
|style="background-color:#CCCCE6" height="16" | [[HR]]
For information on collecting and coding the values, see the [[Glasgow Coma Scale]] article.
| ≥180
*GCS = EYE point + MOTOR point + VERBAL point
| 140-179
*Neurological Points = 15 - GCS
| 110-139
=== Acute Physiologic Score (APS) ===
| &nbsp;
APS = [[#Physiological_Variables]] points + Neurological points from GCS
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 55-69
| 40-54
| ≤39


|-  align="center" valign="top"
==== Inclusion of pH in absence of other ABG components ====
|style="background-color:#CCCCE6" height="16" | [[RR]]
include it
| ≥50
| 35-49
| &nbsp;
| 25-34
|style="background-color:#CCCCE6" | Dec-24
| 10-Nov
| 6-Sep
| &nbsp;
| ≤5


|-  align="center" valign="top"
== [[Age]] Points ==
|style="background-color:#CCCCE6" height="16" | AaDO2 (if FiO2 >= 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" | [[PO2]] (if FiO2 < 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
 
|}
 
== Calculations ==
=== Mean Blood Pressure ===
Mean BP = ((2x Diastolic) + Systolic) ÷  3
 
=== AaDO2 (for Fi02 >= 50 %) ===
AaDO2 = ((FiO2 * 713) - P02) - C02
 
 
== 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 248: Line 68:
  | 5
  | 5
  | 6
  | 6
|}
=== 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 Health Score ==
The chronic health score is calculated from [[Chronic Health APACHE]] and [[Admit Type for APACHE II]] as follows:


Chronic Disease can be one of the following:
=== Correct scoring for Apache II Chronic Health ===
 
: If admit type is: "Medical (non operative)" or "Emergency Surgery" PLUS one or more [[Chronic Health APACHE]] is present:
{| class="wikitable" border=1
:: Score = 5
|-  valign="top"
: If "elective surgery" PLUS one or more [[Chronic Health APACHE]]is present:
|style="background-color:#CCCCE6;font-weight:bold" width="153" height="32" | Liver
::Score = 2
| width="284" |
:if [[Chronic Health APACHE]] is "none" then
'''any''' of
:: Score = 0
* biopsy proven cirrhosis & documented portal hypertension
* past episodes of GI bleeds, hepatic failure encephalopathy, coma
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Cardiovascular
| Class 4 Angina  - pain @ rest or with minimal extertion
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="51" | Respiratory
|
'''any''' of
* COPD
* Restrictive lung disease
* Vascular disease resulting in severe exercise restriction
* documented Hypoxia, hypercapnia, polycythemia 
* Pulmonary HTN
* on home O2
* Ventilator dependent
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Renal
| Receiving Chronic Dialysis
 
|-  valign="top"
|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 CA
|}
 


=== to do before de-stubbing ===
==Total Apache Score==
* where do we pull the chronic data from?
TotApache = APS + Chronic Health points+ agepts
* if we have chronic field (I seem to remember) we should list all its info separately and only give the scoring algorithm here.


== FIO2 Table ==
TotApache MAX =74
see [[FiO2]]


== to do before de-stubbing ==
== Related articles ==  
* finish moving paper content to here.
{{Related Articles}}






{{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"