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
- where is this data taken from? Ttenbergen 22:34, 4 June 2008 (CDT)
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)
Missing Values Rule for APACHE II
If a specific physiological variable in 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 comments and record date time and location this variable was obtained from (e.g. ER or ward). Template:Discussion
- Contents of the Notes field do not get sent with patient data. Is there any sense in taking such a note, then? Ttenbergen 23:23, 4 May 2009 (CDT)
- There is a comment or note section in ACCESS when reviewing files that I use. Do these comments not get sent with the pt data?--MWaschuk 10:28, 5 May 2009 (CDT)
- You caught a hole in documentation here, Mary-Lou. I just made an article for it. No, contents of the Notes field are not sent in. Ttenbergen 13:13, 6 May 2009 (CDT)
- There is a comment or note section in ACCESS when reviewing files that I use. Do these comments not get sent with the pt data?--MWaschuk 10:28, 5 May 2009 (CDT)
If no information is available, then assume it was not tested because it was normal. Record the normal APACHE values for this item. (normal value is the value that give you zero points from the APACHE II scoring table.
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.
B. FOR other APACHE elements-record NORMAL values. Normal values are those items that give you a zero APACHE II point.
- 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.