APACHE physiological variable collection

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.

Where to find lab data

Allan Garland spoke with Dan Roberts, and it was decided that we will proceed as follows in using lab data for this purpose:

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.

The two dead or alive headings below here are almost certainly more general than that. "normal" should be assumed because at the time it was assessed it was not tested because it seemed irellevant - regardless of whether the pt lived. And worst values should be chosen in circumstances were values could not be obtained because pt was too sick, even if they lived. I talked with Trish about this, and she agrees in principle, but we both thought it would be better if you wrangle these into a new form. Ttenbergen 16:12, 2020 December 23 (CST)

• SMW

• Cargo

• Categories

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:

A. For the following vital signs elements-select the lowest limit value on the APACHE score table that will give you the highest score.

• This applies to the following fields:
  • HR - (Heart Rate)
  • BP - (Blood Pressure)
  • RR - (Respiratory Rate)

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.

• This applied to the following fields:
  • Temperature
  • Serum CO2
  • Na -(Sodium)
  • K -(Potassium)
  • Creatinine (APACHE) -(Creatinine)
  • HCT -(Hematocrit)
  • WBC -(White Blood Count)