APACHE physiological variable collection: Difference between revisions

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== When to collect, which value to use ==
== When to collect, which value to use ==
The Higher the APACHE score, the sicker the patient.
See [[Selection and timing of APACHE components]]
 
Select the physiological values that reflect the '''worst''' deviation from normal in the '''first 24 hours''' while "in" the ICU. The clock starts at the '''[[Arrive DtTm ]]'''. If the length of stay in ICU is less than 24, use those values only.
{{DiscussTask |
We decided that a record starts at service acceptance, not unit arrival. This was partly to change the strange exception of [[EMIP]]s. So should this still be "in ICU" or should it now be "on ICU service"? These instructions largely also apply to Medicine, right?  [[User:Ttenbergen|Ttenbergen]] 13:31, 2020 November 25 (CST)
}}
 
The ''Worst'' value could be '''high''' or '''low''', depending which gives the most [[APACHE Scoring table#Chemistry_values| points]].
Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.


=== Exceptionally high or low values ===
=== Exceptionally high or low values ===
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For values outside the '''"absolut" limit''', enter the '''closest value allowed''' and enter a comment into the [[Notes field]]. Also, '''email Pagasa the correct value'''.
For values outside the '''"absolut" limit''', enter the '''closest value allowed''' and enter a comment into the [[Notes field]]. Also, '''email Pagasa the correct value'''.


=== Where to find lab data ===
== Guidelines for the Values to use for APACHE II Physiologic Variables ==
Allan Garland spoke with Dan Roberts, and it was decided that we will proceed as follows in using lab data for this purpose:
=== Use the worst ===
 
*The general rule is to use the '''worst value as per APACHE II rules''' in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, i.e. first [[Service tmp entry]] DtTm.  
i) first use results from testing within the initial 24 hrs in ICU sent to the central lab, if a given test was not performed this way, then go on to (ii)
 
ii) use results from testing within the initial 24 hrs in ICU done on a bloodgas machine (i.e. from an ABG or VBG), if a given lab was also not performed this way, go on to (iii)
 
iii) use the most recent value of that lab done prior to arriving in ICU, from either central lab or done on a bloodgas machine
 
== Missing Values Rule for APACHE II ==
You can not enter 0 for APACHE physiological variables, and you can't leave them blank.
 
== Patient lived ==
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.accdb]].
 
== Patient DIED shortly after arriving in unit ==
We don't want values of dead people.
For patients who died in the unit and have '''no''' data available to record for any one of the physiological variables during their stay on the unit:
 
1. Select the value 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:
=== When not available ===
The following info is relevant if no measurements were taken or in cases of [[Lost/missing chart]].
*You can not enter 0 for any of these, and you can't leave them blank.
*If for a given parameter there are '''no values''' during that initial 24 hours after the start of the profile, you can go back ''prior'' to the start of the ICU record, and use the value closest to the start time of the ICU record (but max 24 hrs prior to admission).
**If there are no values for that parameter either during the first 24 hours OR up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.


'''A.''' For the following vital signs elements-select the '''lowest limit value''' on the APACHE score table that will give you the highest score.  
=== Values during Arrest ===
*This applies to the following fields:
*'''DO NOT''' use vital signs from arrests.  Instead use the worst values from recordings '''OTHER THAN the code sheet'''.
** [[HR]] - (Heart Rate)
*You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
** [[BP]] - (Blood Pressure)
**For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
** [[RR]] - (Respiratory Rate)
*The rationale is that codes are specific, usually short interludes and if it occurs we don't miss it as there should be the ICD10 diagnosis listed for it ([[Cardiac arrest]]).


'''B.''' For other APACHE elements-record '''NORMAL values'''. Normal values are those items that give you a zero APACHE II points. See the individual pages for default "normal" values used.
== Iatrogenically changed values ==
*This applied to the following fields:
*Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
**[[Temperature]]
*However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see [[Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests]]).
**[[Serum CO2]]
**[[Na]] -(Sodium)
**[[K]] -(Potassium)
**[[Creatinine (APACHE)]] -(Creatinine)
**[[HCT]] -(Hematocrit)
**[[WBC]] -(White Blood Count)


== Related articles ==
== Related articles ==

Latest revision as of 13:20, 2024 January 11

When to collect, which value to use

See Selection and timing of APACHE components

Exceptionally high or low values

CCMDB.accdb has error checks for values that are unlikely high or low to prevent errors. The ranges were determined by the statistician based on previous data(see abs min and abs max in APACHE_Scoring_table). To keep the checks meaningful the threshold values will not be changed for extreme outliers.

For values outside the "warning" limit, you must enter the reason for this into the Notes field so that we can validate that these were not errors.

For values outside the "absolut" limit, enter the closest value allowed and enter a comment into the Notes field. Also, email Pagasa the correct value.

Guidelines for the Values to use for APACHE II Physiologic Variables

Use the worst

  • The general rule is to use the worst value as per APACHE II rules in the initial 24 hours of the ICU record (remember that ICU records begin when the patient begins being cared for by the ICU service, i.e. first Service tmp entry DtTm.

When not available

The following info is relevant if no measurements were taken or in cases of Lost/missing chart.

  • You can not enter 0 for any of these, and you can't leave them blank.
  • If for a given parameter there are no values during that initial 24 hours after the start of the profile, you can go back prior to the start of the ICU record, and use the value closest to the start time of the ICU record (but max 24 hrs prior to admission).
    • If there are no values for that parameter either during the first 24 hours OR up to 24 hours prior to the start of the ICU record, APACHE assumes the value was normal -- so code the value that is the midpoint of the normal range per APACHE rules.

Values during Arrest

  • DO NOT use vital signs from arrests. Instead use the worst values from recordings OTHER THAN the code sheet.
  • You can use labs drawn during arrests, but only do so if these are the ONLY labs available.
    • For the lab data, you can use values both from the central laboratory and those done on a bloodgas machine.
  • The rationale is that codes are specific, usually short interludes and if it occurs we don't miss it as there should be the ICD10 diagnosis listed for it (Cardiac arrest).

Iatrogenically changed values

  • Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
  • However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests).

Related articles

Related articles: