APACHE physiological variable collection: Difference between revisions

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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'''.
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'''.


=== Where to find lab data ===
== Guidelines for the Values to use for APACHE II Physiologic Variables ==
Allan Garland spoke with Dan Roberts, and it was decided that we will proceed as follows in using lab data for this purpose:
*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)
i) first use results from testing within the initial 24 hrs in ICU sent to the central lab, if a given test was not performed this way, then go on to (ii)
**What we mean by "worst" is as per APACHE II 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).  
ii) use results from testing within the initial 24 hrs in ICU done on a bloodgas machine (i.e. from an ABG or VBG), if a given lab was also not performed this way, go on to (iii)
**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.
 
*In regards to values that occurred or measured during cardiopulmonary arrests:
iii) use the most recent value of that lab done prior to arriving in ICU, from either central lab or done on a bloodgas machine
**'''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.
== Missing Values Rule for APACHE II ==
*For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
You can not enter 0 for APACHE physiological variables, and you can't leave them blank.
 
{{DA |
* The two dead or alive headings below here are almost certainly more general than that. "normal" should be assumed because at the time it was assessed it was not tested because it seemed irellevant - regardless of whether the pt lived. And worst values should be chosen in circumstances were values could not be obtained because pt was too sick, even if they lived. I talked with Trish about this, and she agrees in principle, but we both thought it would be better if you wrangle these into a new form. [[User:Ttenbergen|Ttenbergen]] 16:12, 2020 December 23 (CST)
}}
 
== Patient lived ==
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).  
 
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.accdb]].
 
== Patient DIED shortly after arriving in unit ==
We don't want values of dead people.
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:  
 
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 points. See the individual pages for default "normal" values used.
*This applied to the following fields:
**[[Temperature]]
**[[Serum CO2]]
**[[Na]] -(Sodium)
**[[K]] -(Potassium)
**[[Creatinine (APACHE)]] -(Creatinine)
**[[HCT]] -(Hematocrit)
**[[WBC]] -(White Blood Count)


== Related articles ==
== Related articles ==

Revision as of 16:28, 12 January 2021

When to collect, which value to use

See Selection and timing of APACHE components

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.

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.

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.

Guidelines for the Values to use for APACHE II Physiologic Variables

  • 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)
    • What we mean by "worst" is as per APACHE II 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.
  • In regards to values that occurred or measured during cardiopulmonary arrests:
    • 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.
  • For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.

Related articles

Related articles:
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