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.
This value is now derived from ICD10 diagnoses, see Change for Apache Chronic to ICD10 from separate variable for details.
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|Data Element (edit)|
Specific chronic pre-existing conditions used for APACHE score.
Legacy implementation right in the table
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.accdb||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.accdb and Centralized data.mdb
- There is an additional option "0HasChronic"; this can not be selected in CCMDB.accdb but is used in Centralized data.mdb for old records that were imported from TMSX and MedTMS where the detailed data was not collected
We are moving to derive this concept from APACHE Comorbidities in ICD10 codes.
- 2022-02-17 - decided to stop collecting this and apply Change for Apache Chronic to ICD10 from separate variable
- 2022-02-09 - Julie, Tina and Allan discussed Julie's most recent analysis of this; there are still many differences in dx vs chronic, with higher and lower counts for different components. Allan quotes a paper that acknowledges this difference in count, but that the Apache score ends up similar. Question raised: is the saving of time in no longer collecting this as a field worth the loss of accuracy.
- 2021-04-22 - preliminary analysis of how deriving this from ICD10 would compare with previous manual collection; many differences; Tina emailed Allan and Julie, more to come
- 2021-04-19 - Added Drug-induced immunosuppression since that component of this code was not previously collected comprehensively
- 2021-03-11 - The list of drugs is at Template:List of immunosuppressive drugs.
- 2021-02-22 - AG sent email to Julie and Tina to get back to this change.
- 2018-11-28 - AG confirmed that this is an option
- when sent for import into TMSX and MedTMS the chronic health score was translated into yes or no; when we moved to Centralized data.mdb these were imported as "0HasChronic"
- 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.