APACHE physiological variable collection

When to collect, which value to use

The Higher the APACHE score, the sicker the patient.

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.

The Worst value could be high or low, depending which gives the most points. 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.

Exceptionally high or low values

CCMDB.mdb 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.

Where to find lab data

Allan Garland spoke with Dan Roberts, and it was decided that we will proceed as follows in using lab data for this purpose:

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)

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)

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

Missing Values Rule for APACHE II

You can not enter 0 for APACHE physiological variables, and you can't leave them blank.

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.mdb.

Use of pre-admission ER LAB results

Template:Discussion The following refers to an ongoing discussion, not to a change in collection rules: As discussed in the 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? Ttenbergen 13:12, 17 October 2008 (CDT)

• 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?Ttenbergen 15:38, 2 May 2011 (CDT)Ttenbergen 19:00, 2012 September 6 (CDT)
  • anyone? Ttenbergen 14:12, 2014 September 19 (CDT)

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 point.

• This applied to the following fields:
  • Temperature
  • Serum CO2 - use 25
  • Na -(Sodium)
  • K -(Potassium)
  • Creatinine (APACHE) -(Creatinine)
  • HCT -(Hematocrit)
  • WBC -(White Blood Count)