Chronic Health APACHE
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)|
Specific chronic pre-existing conditions used for APACHE score.
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:
|2. Met Cancer
|3. HematMalign e.g. Lymphoma or Leukemia
|5. CRF-severe||Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.|
|7. Lung severe||
any of the following that results in severe exercise restriction (i.e. unable to climb stairs or perform household duties):
or any of the following
|8. CVS min exert||Class 4 Angina - pain @ rest or with minimal exertion|
|9. No Chronic Health|
- 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.
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)