Apache Score

Rev. 001 Eff. Date: June 17, 2005 Owner: Critical Outcomes

APACHE IV Calculations 31TRGEXT000013

INSTRUCTIONS

To Calculate APS Score:

Following the methodology precisely, determine the physiological variable furthest from the reference point, whether higher or lower/above or below. Assign APS points to that single, most deviant value. Resources for the correct collection of data elements: 1. Knaus WA, Wagner DP, Draper EA, Zimmerman JE. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100:1619-1636. 2. http://train.apacheweb.com/apacheIIIwebcourse/courselogin/login. cfm The accuracy of APACHE predictions is dependent upon the quality of data upon which predictions are made. Deviations from the precise data collection methodology may result in errors in prediction which Cerner Corporation cannot be responsible for.

To determine disease category

Using the disease mapping table, select the single primary reason for ICU admission. Patients coming to the ICU from the operating room or post-anesthesia care unit must be assigned surgical diagnoses. ALL OTHER PATIENTS will receive a non-operative diagnosis. Diseases are categorized by body system, and then into operative and non-operative categories for ease of use of this table.

Tab 1, p. 1 of 36 Reviewed by: Fern Malila Approved by: Kim Hlobik

Rev. 001 Eff. Date: June 17, 2005 Owner: Critical Outcomes

APACHE IV Calculations 31TRGEXT000013

Determine the disease category associated with the ICU admitting diagnosis.

To calculate hospital mortality and/or ICU length of stay

First, select the appropriate worksheet for the prediction required and the patient (CABG, Non-CABG) type Enter the required values or use 1=yes, blank=no. For each set of variables, the options within each color block are mutually exclusive. Select only one of the options as a "yes" (1), the rest "no" (0) or blank. More than one selection from a single group will result in an error message. Example: If disease category is SCAROTID=1, all other disease categories=blank.

Additional Notes

Error messages will appear in red if more than one mutually exclusive variable is selected. All cells except those that accept data for the calculations are "locked".

Tab 1, p. 2 of 36 Reviewed by: Fern Malila Approved by: Kim Hlobik

Rev. 001 Eff. Date: June 17, 2005 Owner: Critical Outcomes

Tab 2, p. 3 of 36 Reviewed by: Fern Malila Approved by: Kim Hlobik

APACHE IV Calculations 31TRGEXT000013

Step 1: Calculate Acute Physiology Score follows, entering the appropriate point value in the blue box to the right of each category: Pulse (beats/min) Select heart rate furthest from 75

=155

8 5 0 1 5 7 13 17

Pulse points

0

Mean Blood Pressure (MAP) Select MAP furthest from 90

=140

23 15 7 6 0 4 7 9 10

MAP points

0

=40

20 16 13 8 2 0 4

Temperature points

0

Respiratory Rate (breaths/min)* Select respiratory rate furthest from 19 *for patients who are ventilated no points are given for respiratory rates of 6-12.

=50

17 8 7 0 6 9 11 18

Respiratory rate points

PaO2 (mmHg)* *Use only for non-intubated patients or intubated patients with FiO2 =0.5 (50%). Do not use PaO2 weights for these patients.

=500

0 7 9 11 14

=50

3 0 3

WBC (cu/mm) Select WBC furthest from 11.5.

=25

19 5 0 1 5

Creatinine without ARF* (mg/dl) Select creatinine furthest from 1.0.

=1.95

3 0 4 7

0-1.4 >=1.5

0 10

Creatinine with ARF points

=4000

15 8 7 5 4 0 1

Urine output points

=80

0 2 7 11 12

BUN points

=1.5 mg/dl as creatinine >=1.5 mg/dl and urine output =155

2 0 4

Albumin (g/dl) Select albumin furthest from 3.5.

=4.5

11 6 0 4

Albumin points

Bilirubin (mg/dl) Select highest bilirubin (furthest from 0)

=8.0

0 5 6 8 16

Bilirubin points

=350

8 9 0 3 5

Glucose points

Glucose (mg/dl)* Select glucose furthest from 130 *Glucose