APACHE Acute Diagnoses

From CCMDB Wiki

This is about the disease category which is one of the components in the model of predicting hospital mortality. The other components of the model are the APACHE Score and the presence or absence of Emergency Surgery (concept).

This is not about Chronic Health APACHE or the APACHE Comorbid Diagnoses.

Indicators
Indicator: ICU Diagnostic Categories by APACHE II
Created/Raw: Created
Program: Critical Care
Start Date: Oct 2016
End Date:
Reports: No reports on this wiki list this as an indicator.


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How to Determine the Diagnosis Category For each Patient

  • Each disease category or diagnosis leading to ICU admission has an associated weight in the model and varies for non-operative and post-operative patients.
    • Post-operative patients are those with Previous Location either Operating Room or Recovery Room.
  • There are weights for specific diagnosis categories and for major organ systems. The specific diagnosis category leading to ICU admission will first be determined based on the priority list in the descending order of the weights and if found none, then the major organ system following the priority list also in descending order will be used instead.
    • For non-operative patients, there are 24 specific diagnosis categories while 18 for post-operative patients; total of 42 which are shown in the S_ICD10_APACHE_Dx_patterns table.
    • There are 5 major vital organ system for both non-operative and post-operative patients (e.g. Nuerological, Cardiovascular, Respiratory, Gastrointestinal, Metabolic/renal) and all others NOS.
  • The diagnosis having the highest weight is assigned to the patient.
  • The 42 diagnosis categories are further grouped into eight major diagnostic categories for reporting purposes namely:
    • Respiratory Disorders, Cardiac Disease, Post Cardiac Arrest, Neurologic Disorders,
    • Trauma and Poisoning, Post-Operative Care, Metabolic/Renal/GI/Hypovolemic Shock, Sepsis and Septic Shock

ICD10 Mapping of Diagnosis Category

  • Before Jan 2019, Drs. Carla Chrusch and Kendiss Olafson did the mapping of the old admit diagnosis coding to the diagnosis categories included in the model.
  • Starting Jan 2019, Dr. Allan Garland did the mapping of the admit ICD10 codes and CCI codes to the diagnosis categories included in the model.
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JALT

  • The list of admit CCI procedures used in combination with the admit ICD10 codes is shown in
    • There are many questions about that list, I have emailed Julie and Allan for more info. Ttenbergen 16:38, 2022 June 15 (CDT)
      • Allan has provided newest list, but there were version control issues. Allan to sent the current master version to Tina and Julie as of today's JALT. Ttenbergen 10:11, 2022 July 27 (CDT)
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Notes from reviewing the list

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just Tina's working notes: Scenarios:

  • one of a * of ICD10s
  • one of a * of ICD10s AND one of a * of ICD10s
  • one of a * of ICD10s AND an ICD10 with a word in it
  • one of a * of ICD10s AND one of a * of CCIs
  • one of a * of CCIs
  • two or more of a * of ICD10s

AND any admit procedure is EITHER: (a) of the form 1.AA.xx, 1.AB.xx, 1.AC.xx, 1.AE.xx, 1.AD.xx, 1.AG.xx, 1.AJ.xx, 1.AK.xx, 1.AN.xx, 1.AP.xx

where “xx” = any of 13, 51, 52, 53, 56, 57, 59, 72, 76, 80, 87, 89, 90, 91

or (b) 2.AA.71.yy, 2.AB.71.yy, 2.AC.71.yy, 2.AE.71.yy, 2.AD.71.yy, 2.AG.71.yy, 2.AJ.71.yy, 2.AK.71.yy, 2.AN.71.yy, 2.AP.71.yy

where “yy” = any of 70.^, 71.^
  • one of a * of ICD10s AND (one of * of CCI1 and a * of CCI2)
    • might be able to do a pattern recognition on that? Or a regular expression?
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Allan updated the original list and documented some reasons for decisions at item 13 in Task Team Meeting - Rolling Agenda and Minutes 2022#‎ICU Database Task Group Meeting – July 13, 2022.

Implementation in CCMDB

The

draws on the

The contents of the

are then used by the

to provide the list of ICD10 APACHE Acute Diagnoses for patient records.

For a list of these diagnoses on this wiki, see

For a list of these CCI procedures on this wiki, see

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same as above

  • added: no added date
  • action: no action date
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Reporting of the Eight Major Diagnostic Categories

  • Reported as counts and percentage by unit and time period
  • Graphically as stackable vertical bar chart
  • Time period - quarterly

Report Users

  • Critical Care Directors and Site Managers
  • Critical Care Quality Improvement Team (QIT)

SAS Program

  • S:\MED\MED_CCMED\Julie\SAS_CFE\CC_reports\ChartReport\1-prepCC_QI_startJan2022.sas
  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\ICD10_ApachePredHospMort_byPriority.sas
  • S:\MED\MED_CCMED\Julie\SAS_CFE\CC_reports\ChartReport\3-prepCCChart_ApacheDxGrp_94_startJan2020.sas

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