APACHE Scoring table: Difference between revisions

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The '''Scoring table''' for [[:category:APACHE II|APACHE II]] describes how various fields we collect affect the ultimate APACHE II score. The score itself is automatically calculated, no manual addition needs to be performed.  
The '''Scoring table''' for [[:category:APACHE II|APACHE II]] describes how various fields we collect affect the ultimate APACHE II score.  


== Chemistry Values==
The calculation of the store happens automatically and data collectors do not need to fit patient scores into this ranking or perform calculations.
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
|- style="background-color:#CCCCE6;font-weight:bold" align="center" valign="top"
| width="125" height="16" | Points
| width="48" | 4
| width="48" | 3
| width="48" | 2
| width="48" | 1
| width="48" | 0
| width="48" | 1
| width="48" | 2
| width="48" | 3
| width="48" | 4


|-  align="center" valign="top"
== Physiological Variables ==
|style="background-color:#CCCCE6" rowspan="2" height="15" | [[Temperature]]
MAX score = 48
| rowspan="2" | ≥41
{{#ask: [[Category:APACHE II Physiological Variables]]  
| rowspan="2" | 39-40.9
| ?AP phys name
| rowspan="2" | &nbsp;
| ?AP phys unit
| rowspan="2" | 38.5-38.9
| ?AP phys absMax
|style="background-color:#CCCCE6" rowspan="2" | 36-38.4
| ?AP phys warnMax
| rowspan="2" | 34-35.9
| ?AP H4
| rowspan="2" | 32-33.9
| ?AP H3
| rowspan="2" | 30-31.9
| ?AP H2
| ≤
| ?AP H1
| ?AP 0
| ?AP L1
| ?AP L2
| ?AP L3
| ?AP L4
| ?AP phys warnMin
| ?AP phys absMin
|sort=AP phys name
|order=ascending
|format=broadtable
|default=Problem with SMW ask call
|headers=show
|class=sortable wikitable smwtable
}}


|-  align="center" valign="top"
== definitions ==
| 29.9
A lot of these values follow very specific definitions and collection instructions. See individual linked articles for details. Especially, see
* [[Mean BP]]
* [[Arterial blood gas (APACHE)]]
* [[Glasgow Coma Scale]]


|-  align="center" valign="top"
=== number of decimal points in definitions ===
|style="background-color:#CCCCE6" height="16" | [[m BP]]
Some values arrive with a higher decimal precision than the definitions. Since the definitions have holes, that would lead to values in the holes being undefined for points.
| ≥160
This is solved by rounding the value to one decimal point and applying the score to that.
| 130-159
| 110-129
| &nbsp;
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 50-69
| &nbsp;
| ≤49


|-  align="center" valign="top"
=== [[Glasgow Coma Scale]] (GCS) ===
|style="background-color:#CCCCE6" height="16" | [[HR]]
For information on collecting and coding the values, see the [[Glasgow Coma Scale]] article.
| ≥180
*GCS = EYE point + MOTOR point + VERBAL point
| 140-179
*Neurological Points = 15 - GCS
| 110-139
=== Acute Physiologic Score (APS) ===
| &nbsp;
APS = [[#Physiological_Variables]] points + Neurological points from GCS
|style="background-color:#CCCCE6" | 70-109
| &nbsp;
| 55-69
| 40-54
| ≤39


|-  align="center" valign="top"
==== Inclusion of pH in absence of other ABG components ====
|style="background-color:#CCCCE6" height="16" | [[RR]]
include it
| ≥50
| 35-49
| &nbsp;
| 25-34
|style="background-color:#CCCCE6" | Dec-24
| 10-Nov
| 6-Sep
| &nbsp;
| ≤5


|-  align="center" valign="top"
== [[Age]] Points ==
|style="background-color:#CCCCE6" height="16" | AaDO2 (if FiO2 >= 50%)
| ≥500
| 350-499
| 201-349
| &nbsp;
|style="background-color:#CCCCE6" | 200
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[PO2]] (if FiO2 < 50%)
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|style="background-color:#CCCCE6" | 70
| 61-69
| &nbsp;
| 55-60
| ≤54
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Arterial pH]]
| ≥7.7
| 7.6-7.69
| &nbsp;
| 7.5-7.59
|style="background-color:#CCCCE6" | 7.33-7.49
| &nbsp;
| 7.25-7.32
| 7.15-7.24
| ≤ 7.14
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Serum CO2]] (If no ABG)
| ≥52
| 41-51.9
| &nbsp;
| 32-40.9
|style="background-color:#CCCCE6" | 22-31.9
| &nbsp;
| 18-21.9
| 15-17.9
| ≤14
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[Na]]
| ≥180
| 160-179
| 155-159
| 150-154
|style="background-color:#CCCCE6" | 130-149
| &nbsp;
| 120-129
| 111-119
| ≤110
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[K +]]
| ≥7
| 6-6.9
| &nbsp;
| 5.5-5.9
|style="background-color:#CCCCE6" | 3.5-5.4
| 3-3.4
| 2.5-2.9
| &nbsp;
| ≤2.4
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="26" | [[Creat]] (*Double point if yes for  [[ARF]])
| ≥309
| 178-308
| 133-177
| &nbsp;
|style="background-color:#CCCCE6" | 53-132
| &nbsp;
| 52
| &nbsp;
| &nbsp;
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[HCT]]
| ≥60
| &nbsp;
| 50-59.9
| 46-49.9
|style="background-color:#CCCCE6" | 30-45.9
| &nbsp;
| 20-29.9
| &nbsp;
| ≤19
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="16" | [[WBC]]
| ≥40
| &nbsp;
| 20-39.9
| 15-19.9
|style="background-color:#CCCCE6" | 3-14.9
| &nbsp;
| 1-2.9
| &nbsp;
| <1
|}
 
== Glasgow Coma Scale ==
For information on collecting and coding the values, see the [[Glasgow Coma Scale]] article.
 
A Glasgow Coma Scale score of 15 would be considered "Total Neuro Points".
 
The Glasgow Coma Scale is scored in APACHE II as follows:
 
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext>
|- style="background-color:#CCCCE6;font-weight:bold" align="center" valign="top"
| width="125" height="16" | Points
| width="64" | 6
| width="58" | 5
| width="48" | 4
| width="48" | 3
| width="48" | 2
| width="48" | 1
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="27" | EYES
| &nbsp;
| &nbsp;
| Spontaneous
| To Speech
| To Pain
| None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="39" | MOTOR
| Obeys Command
| Localizes Pain
| Withdraws to Pain
| Abnormal Flexion
| Abnormal Extension
| None
 
|-  align="center" valign="top"
|style="background-color:#CCCCE6" height="38" | VERBAL
| &nbsp;
| Oriented
| Confused
| Inappropriate words
| Incomprehensive sounds
| None
 
|}
 
== Calculations ==
=== Mean Blood Pressure ===
Mean BP = ((2x Diastolic) + Systolic) ÷  3
 
=== AaDO2 (for Fi02 >= 50 %) ===
AaDO2 = ((FiO2 * 713) - P02) - C02
 
 
== Age Points ==
The age of the patient is automatically generated from the [[DOB field|date of birth]] and the date of admission when collecting data.  
The age of the patient is automatically generated from the [[DOB field|date of birth]] and the date of admission when collecting data.  


{| class="wikitable" border=1  
{| class="wikitable" border=1  
|- style="background-color:#CCCCE6;font-weight:bold" valign="top" align="center"  
|- style="background-color:#CCCCE6;font-weight:bold"  
| width="58" height="16" | Age
|| Age
| width="48" | ≤44
|| ≤44
| width="48" | 45-54
|| 45-54
| width="48" | 55-64
|| 55-64
| width="48" | 65-74
|| 65-74
| width="48" | ≥75
|| ≥75


|- align="center" valign="top"
|-
|style="font-weight:bold" height="16" | Points
|style="font-weight:bold" | Points (agepts)
  | 0
  | 0
  | 2
  | 2
Line 248: Line 68:
  | 5
  | 5
  | 6
  | 6
|}
=== before de-stubbing ===
* confirm if age calculated from admission date
== Chronic Health ==
We pull some of the values for the chronic health score from the coded diagnoses and some from ...
The [[Chronic health field]] is scored as follows:
{| class="wikitable" border=1
|- style="background-color:#CCCCE6;font-weight:bold" valign="top"
| width="75" height="40" | Points
|style="font-weight:bold" width="75" | 0
|style="font-weight:bold" width="100" | 2
|style="font-weight:bold" width="150" | 5
|- valign="top"
|style="background-color:#CCCCE6" height="52" | Chronic Health  Status
| No history of chronic disease
| Elective Post op with history of chronic disease
| Non OP (medical) or emergency post op with history of chronic disease


|}
|}


== Chronic Health Score ==
The chronic health score is calculated from [[Chronic Health APACHE]] and [[Admit Type for APACHE II]] as follows:


Chronic Disease can be one of the following:
=== Correct scoring for Apache II Chronic Health ===
 
: If admit type is: "Medical (non operative)" or "Emergency Surgery" PLUS one or more [[Chronic Health APACHE]] is present:
{| class="wikitable" border=1
:: Score = 5
|-  valign="top"
: If "elective surgery" PLUS one or more [[Chronic Health APACHE]]is present:
|style="background-color:#CCCCE6;font-weight:bold" width="153" height="32" | Liver
::Score = 2
| width="284" |
:if [[Chronic Health APACHE]] is "none" then
'''any''' of
:: Score = 0
* biopsy proven cirrhosis & documented portal hypertension
* past episodes of GI bleeds, hepatic failure encephalopathy, coma
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Cardiovascular
| Class 4 Angina  - pain @ rest or with minimal extertion
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="51" | Respiratory
|
'''any''' of
* COPD
* Restrictive lung disease
* Vascular disease resulting in severe exercise restriction
* documented Hypoxia, hypercapnia, polycythemia 
* Pulmonary HTN
* on home O2
* Ventilator dependent
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="15" | Renal
| Receiving Chronic Dialysis
 
|-  valign="top"
|style="background-color:#CCCCE6;font-weight:bold" height="64" | Immuno-compromised
| Receiving therapy that suppresses resistance to infection such as
* Chemo
* Radiation
* ≥10 mg prednisone
* ≥15mg/kg/day hydrocortisone
* >3 mg/kg’day of methyoprednisolone for >5 days
or sufficiently advanced disease to suppress resistance to infection
* Leukemia
* lymphoma Aids
* metastatic CA
|}
 


=== to do before de-stubbing ===
==Total Apache Score==
* where do we pull the chronic data from?
TotApache = APS + Chronic Health points+ agepts
* if we have chronic field (I seem to remember) we should list all its info separately and only give the scoring algorithm here.


== FIO2 Table ==
TotApache MAX =74
see [[FiO2]]


== to do before de-stubbing ==
== Related articles ==  
* finish moving paper content to here.
{{Related Articles}}






{{stub}}
[[Category:APACHE II | *]]
[[Category:APACHE II]]
[[Category:APACHE II Physiological Variables | *]]
[[Category:ABG]]

Latest revision as of 13:48, 2023 May 4

The Scoring table for APACHE II describes how various fields we collect affect the ultimate APACHE II score.

The calculation of the store happens automatically and data collectors do not need to fit patient scores into this ranking or perform calculations.

Physiological Variables

MAX score = 48

 AP phys nameAP phys unitAP phys absMaxAP phys warnMaxAP H4AP H3AP H2AP H1AP 0AP L1AP L2AP L3AP L4AP phys warnMinAP phys absMin
AaDO2Alveolar-arterial oxygen tension difference>500>=350 and <500>=200 and <350<200
AP Dias BP FieldDiastolic blood pressuremmHG200128as per Mean BP2515
HRHeart Ratebeats/min205250>=180>=140 and <180>=110 and <140>=70 and <110>=55 and <70>=40 and <55<40105
KPotassiummmol/L129.9=>7>=6 and <7>=5.5 and <6>=3.5 and <5.5>=3 and <3.5>=2.5 and <3<2.511
Serum CO2Serum CO2mmol/L440285≥52>=41 and <52>=32 and <41>= 22 and <32>=18 and <22>=15 and <18<1522
NaSodiummmol/L200190>=180>=160 and <180>=155 and <160>=150 and <155>=130 and <150>=120 and <130>=111 and <120≤11110070
AP Sys BP FieldSystolic Blood PressuremmHG360243as per Mean BP4925
TemperatureTemperature°C42.742.7>=41>=39 and <41>=38.5 and <39>=36 and <38.5>=34 and <36>=32 and <34>=30 and <32<3011
WBCWhite Blood Countx109/L517301>=40>=20 and <40>=15 and <20>=3 and <15>=1 and <3<10.020.01
FiO2fraction of inspired oxygenpercentage100100as per AaDO22020
HCThematocritpercentage33>=60>=50 and <60>=46 and <50>=30 and <46>=20 and <30<206878
Mean BPmean blood pressuremmHG>=160>=130 and <160>=110 and <130>=70 and <110>=50 and <70<49
PCO2partial pressure of carbon dioxide in arterial bloodmmol/L440285AaDO222
PO2partial pressure of oxygenmmHG650650>=70>=60 and <70>=55 and <60<5543
PHph7.997.97>=7.7>=7.6 and <7.7>=7.5 and <7.6>=7.33 and <7.5>=7.25 and <7.33>=7.15 and <7.25<7.1566
RRrespiratory ratebreaths/min9579>=50>=35 and <50>=25 and <35>=12 and <25>=10 and <12>=6 and <10<622
Creatinine (APACHE)serum creatinineµmol/L>=309>=178 and <309>=133 and <178>=53 and <133≤5252

definitions

A lot of these values follow very specific definitions and collection instructions. See individual linked articles for details. Especially, see

number of decimal points in definitions

Some values arrive with a higher decimal precision than the definitions. Since the definitions have holes, that would lead to values in the holes being undefined for points. This is solved by rounding the value to one decimal point and applying the score to that.

Glasgow Coma Scale (GCS)

For information on collecting and coding the values, see the Glasgow Coma Scale article.

  • GCS = EYE point + MOTOR point + VERBAL point
  • Neurological Points = 15 - GCS

Acute Physiologic Score (APS)

APS = #Physiological_Variables points + Neurological points from GCS

Inclusion of pH in absence of other ABG components

include it

Age Points

The age of the patient is automatically generated from the date of birth and the date of admission when collecting data.

Age ≤44 45-54 55-64 65-74 ≥75
Points (agepts) 0 2 3 5 6

Chronic Health Score

The chronic health score is calculated from Chronic Health APACHE and Admit Type for APACHE II as follows:

Correct scoring for Apache II Chronic Health

If admit type is: "Medical (non operative)" or "Emergency Surgery" PLUS one or more Chronic Health APACHE is present:
Score = 5
If "elective surgery" PLUS one or more Chronic Health APACHEis present:
Score = 2
if Chronic Health APACHE is "none" then
Score = 0

Total Apache Score

TotApache = APS + Chronic Health points+ agepts

TotApache MAX =74

Related articles

Related articles: