APACHE II

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APACHE II is a severity of disease classification system (Knaus et al., 1985). Its name stands for "Acute Physiology and Chronic Health Evaluation II", and is one of several ICU scoring systems.

[edit] Application

APACHE II was designed to measure the severity of disease for adult patients admitted to Intensive care units. The lower age is not specified in the original article, but a good limit is to use Apache II only for patients age 15 or older.

24 hours after admission to the ICU, the measurement has been completed and resulted in an integer point score between 0 and 71. No new score can be calculated during the stay. If a patient is discharged from the ICU and readmitted, a new APACHE II score can be calculated.

This scoring systems is used in many ways:

  • Some procedures and some medicine is only given to patients with certain APACHE II score
  • APACHE II score can be used to describe the morbidity of a patient when comparing the outcome with other patients.
  • Predicted mortalities are averaged for groups of patients in order to specify the group's morbidity.

Even though newer scoring systems, like SAPS II have replaced APACHE II in many places, APACHE II continues to be used extensively because so much documentation is based on it.

[edit] Calculation

The point score is calculated from 12 routine physiological measurements during the first 24 hours, information about previous health status and some information obtained at admission. The calculation method is optimized for paper schemas. The resulting point score should always be interpreted in relation to the illness of the patient.

The appendix of the document that originally described the APACHE II score, makes an attempt to describe how to calculate a predicted death rates for a patient. This is pure statistics, however, and does not relate to an individual patient's chance of survival. The main purpose of this calculation is to provide a value that can be averaged for a group of patients, since it gives very unprecise values to calculate an average of the scores of a group of patients. In order to make this calculation of predicted mortality precise, the principal diagnose leading to ICU admission was added as a category weight. In other words, the predicted mortality is based on more information than just the APACHE II score.

[edit] References

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