APACHE II Background

APACHE stands for Acute Physiological and Chronic Health Evaluation

Who was it developed by

Developed by Dr. William A. Knaus et.al. George Washington University Medical Center in 1978. Has been validate in many centers since then and shown to be a strong and stable predictor of hospital survival. APACHE II was develop in 1985. (APACHE II, 1991).

Purpose

Designed to be a objective and quantitative measure of the severity of illness of acutely ill patient in ICU. The severity of disease classification system also assists in the ability to prognosticate outcome or evaluate the impact of subsequent care in ICU. APACHE scores can help identify those patient that would or would not benefit from ICU admission and treatment.

What are the components

• APS— The Acute Physiology Score

12 physiological variables from one or more of the body’s seven major vital physiologic systems: neurological, cardiovascular, respiratory, gastrointestinal, renal, metabolic & hematologic. Captures acute severity of illness. (max score = 60)

• Age group (max score = 6)
• history of a underlyingChronic Health condition reflecting diminished physiologic reserve (max score = 5).

Max Total Apache Score = 71

Weighting of scores

Each physiological variable selected has been weighted with a score ranging from 0-4 points to reflect severity.

Physiological variables with the worst deviation from normal have been asigned the higher points.

Timing of collection

Deviation in physiologic variables are selected during a patients first 24 hours in ICU.

How were these Varibles Selected

Knaus and his team, which included a panel of 7 experienced ICU physicians from major centers and specialies, reviewed literature for measurements that had demonstrated promise in estimating severity of illness and that were generally tested and recorded in most ICU’s. The weighted score that the panel assigned to particular physiologic values was based on the fact that the more deviated from normal the value was, the more concern and by inference, the more severly ill a patient is.

to do before de-stubbing

• finish moving paper content to here.