Apache II General Collection Guidelines

When to collect, which value to use

• Select the physiological values that reflect the worst deviation from normal in the first 24 hours in ICU.

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

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.

If the length of stay in ICU is less than 24, use those values only.

• NOTE: The Higher the APACHE score, the sicker the patient.

Discussion

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 preceeding admission to the ICU may be admissible data for APACHE values if 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)

Missing Values Rule for APACHE II

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.

Missing Values Rules for APACHE II for patients who DIED shortly after arriving in unit

Patients who have died in the unit and have NO data available to record for an APACHE II:

1. select the physiological variable 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:
  • T -Temperature
  • CO2 -serum CO2 - use 25
  • Na -(Sodium)
  • K -(Potassium)
  • CREAT -(Creatinine)
  • HCT -(Hematocrit)
  • WBC -(White Blood Count)

• applies to those patient who have been admitted to ICU and die shortly after admission. The guidelines outlines which apache values to use. No blanks and no zero's. We don't want values of dead people. Choose values closet to the time of admission if there are any, if there are no values, then follow the rules above.

12 Physiological Variables

1. Temperature
2. Mean BP mean blood pressure
3. HR( Heart Rate)
4. RR (Respiratory Rate)
5. ABG No ABG Available Rule? use serum CO2
6. PH
7. Na
8. K
9. CREAT
10. HCT
11. WBC
12. GCS Glasgow Coma Scale

NOTE: If values for labs are beyond the pre-set limits in CCMDB.mdb, put in the highest or lowest value allowed and then, after sending the profile, contact Pagasa to put in the correct value. The rationale for this is that the pre-set limits are important to prevent errors and will not be changed for extreme outliers.