Chronic Health APACHE

From CCMDB Wiki
This article is about Chronic Health in the context of the APACHE score, see Comorbid Diagnosis for info on the comorbidities we collect, and Charlson Comorbidity Index for the Charlson comorbidities that are also used for the Alert score.


Data Element (edit)
Field Name: Ap_Chronic
CCMDB Label: Chronic
CCMDB tab: Apache
Table: L_Log table
Data type: string
Length: 30
Program: CC
Created/Raw: Raw
Start Date: 1900-01-01
End Date: 2300-01-01
Sort Index: 56

Specific chronic pre-existing conditions used for APACHE score.


Poindexter.jpg

Dx grouping

  • AG REPLY -- Tina I don't know what the question is here.
    • just flagging it to sort with the others so we can deal with it when we address them.

This value is used in conjunction with Admit Type for APACHE II to calculate the Chronic_Health_Score, one of the components of the.

To be considered to be a chronic disease, the chronic condition must have been documented as present before current hospitalization.

Chronic Health Table

Dropdown in CCMDB.mdb Orignial APACHE II CH list with definitions
1. Immunocompromized (this category includes the following: Metastatic Cancer, Hematological Malignancy-Lymphoma, Leukemia and also AIDS) (this is applicable to items 1-5. Receiving therapy that suppresses resistance to infection such as: at least one of the following:
  • ≥15mg/kg/day hydrocortisone
  • >3 mg/kg’day of methylprednisolone for >5 days (for entire LOS if pts LOS is less than 5 days).
  • ≥10 mg prednisone
  • Chemotherapy
  • Radiation therapy
  • Post BMT (Bone Marrow Transplant)
  • sufficiently advanced disease to suppress resistance to infection
  • Include patients on methotrexate or cyclophosphamide, etc. (for autoimmune disorders)
  • pt is on immunosuppressive drugs (RA or SLE pts)
2. Met Cancer
  • sufficiently advanced disease to suppress resistance to infection
3. HematMalign e.g. Lymphoma or Leukemia
  • sufficiently advanced disease to suppress resistance to infection
4. AIDS
5. CRF-severe Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.
6. Liver-severe

any of:

  • biopsy proven cirrhosis & previously documented portal hypertension
  • past episodes of
    • GI bleeds related to portal hypertension or varicies
    • hepatic failure or encephalopathy or coma
7. Lung severe

any of the following that results in severe exercise restriction (i.e. unable to climb stairs or perform household duties):

  • COPD-severe
  • Restrictive lung disease-severe
  • Vascular disease-severe

or any of the following

  • documented chronic hypoxia or hypercapnia,
  • secondary polycythemia
  • Pulmonary HTN
  • on home O2 (this does not include home bipap or cpap unless the pt also has one of the other listed conditions)Bipap or cpap if only for airway does not imply lung disease. Cpap for obstructive sleep apnea is just constant positive air pressure to keep the airway open during sleep. Not usually used with oxygen.
  • Ventilator dependent
    • Does being on bipap or cpap for obesity be considered restrictive lung disease severe?--MWaschuk 14:31, 2012 May 28 (CDT)
    • There may be an element of restrictive lung disease with obesity as the lung cannot always fully expand related to pressure on the diaphragm of a morbidly obese pt. To be considered true restrictive lung disease however, this must result in impaired ventilatory function. Most obese pts on bipap are only on bipap at night to maximize the airway. To call this severe restrictive lung disease is incorrect. If they are on home O2 during the day as well or have any of the above issues like documented hypoxia or hypercapnea, then this would be considered severe restrictive lung disease. Bipap at night alone is not sufficient evidence of severe restrictive lung disease even if the pt is obese. --LKolesar 07:16, 2012 May 29 (CDT)
8. CVS min exert Class 4 Angina - pain @ rest or with minimal exertion
9. No Chronic Health

Implementation

  • Chronic Health is stored as a single-choice dropdown in CCMDB.mdb
  • when sent for import into TMSX the chronic health score is translated into yes or no
  • the fields were made into a pick list of 9 items that belong to one of the five APACHE II Chronic Health categories because Medicine wanted to use both APACHE II and SAPS II on Medicine patients. SAPS II and APACHE II scored these same chronic health items differently. SAPS is no longer collected.

5 items in Apache vs 8/9 on our list

In articles on-line, the Chronic health section only has the following 5 categories:

  • 1. Liver
  • 2. Cardiovascular
  • 3. Respiratory
  • 4. Renal
  • 5. Immunocompromised: In this section they include the cancer patients on chemo, radiation. They also include leukemia and lymphoma and they include AIDS.

To me this makes more sense than having a separate category for metastatic cancer and AIDS and hematologic malignancies. The danger in having these separate categories is that people may include past histories of these conditions when they no longer apply to the apache criteria which is the fact that they are immunocompromised at this time.--LKolesar 08:00, 2017 October 4 (CDT)

  • AG REPLY --- yes, you are right, APACHE II has only those 5 categories of comorbid conditions, and the other items above are, in APACHE, folded into those 5. And also yes, past histories should NOT be included in any of the five categories of APACHE comorbids.
    • I am not sure what the actual question was here, but taking out the discussion tag since these will likely be done differently in ICD10 after we roll out.

ICD10

We are considering changing how this is collected to extracting the data from APACHE Comorbidities in ICD10 codes instead of coding a separate field. Further discussions to come.

Example dx: Pulmonary hypertension, secondary (any cause)