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. [[Accept DtTm]] resp [[Service tmp entry]] dttm) , not when he/she arrives in the ICU (ie. [[Arrive DtTm]] resp [[Boarding Loc]]))

=== When not available ===

*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 (i.e. [[Accept DtTm]] resp [[Service tmp entry]] dttm) , not when he/she arrives in the ICU (ie. [[Arrive DtTm]] resp [[Boarding Loc]]))

*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the ICU record, 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 for a given parameter there are NO values during that initial 24 hours after the start of the ICU record, 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.

=== Values during Arrest ===

*In regards to values that occurred or measured during cardiopulmonary arrests (e.g. [[Cardiac arrest]]):

**'''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.

== 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. [[Accept DtTm]] resp [[Service tmp entry]] dttm) , not when he/she arrives in the ICU (ie. [[Arrive DtTm]] resp [[Boarding Loc]]))
+=== When not available ===
 *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 (i.e. [[Accept DtTm]] resp [[Service tmp entry]] dttm) , not when he/she arrives in the ICU (ie. [[Arrive DtTm]] resp [[Boarding Loc]]))
+*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the ICU record, 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 for a given parameter there are NO values during that initial 24 hours after the start of the ICU record, 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.
+=== Values during Arrest ===
 *In regards to values that occurred or measured during cardiopulmonary arrests (e.g. [[Cardiac arrest]]):
 **'''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.
+== 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 ==