APACHE II
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An APACHE II is an ICU scoring system that grades the disease severity in an adult patient based on the APACHE model.
- AKA: Acute Physiologic Assessment and Chronic Health Evaluation II.
- Context:
- It is a point score system based on 12 physiologic variables
- Example(s):
- Counter-Example(s):
- See: ICU Scoring System, Mortality Probability Model (MPM), APACHE Model, Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA).
References
2016
- (Wikipedia, 2015) ⇒ http://wikipedia.org/wiki/APACHE_II
- QUOTE: APACHE II ("Acute Physiology and Chronic Health Evaluation II") is a severity-of-disease classification system (Knaus et al., 1985), one of several ICU scoring systems. It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death. The first APACHE model was presented by Knaus et al. in 1981.
2015
- (Caballero Barajas & Akella, 2015) ⇒ Karla L. Caballero Barajas, and Ram Akella. (2015). “Dynamically Modeling Patient's Health State from Electronic Medical Records: A Time Series Approach.” In: Proceedings of the 21st ACM SIGKDD International Conference on Knowledge Discovery and Data Mining (KDD-2015). ISBN:978-1-4503-3664-2 doi:10.1145/2783258.2783289
2014
- (Merck Manuals, 2014) ⇒ http://www.merckmanuals.com/professional/critical-care-medicine/approach-to-the-critically-ill-patient/critical-care-scoring-systems
- QUOTE: Several scoring systems have been developed to grade the severity of illness in critically ill patients. These systems are moderately accurate in predicting individual survival. However, these systems are more valuable for monitoring quality of care and for conducting research studies because they allow comparison of outcomes among groups of critically ill patients with similar illness severity.
- The most common system is the 2nd version of the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score introduced in 1985. It generates a point score ranging from 0 to 71 based on 12 physiologic variables, age, and underlying health (see Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring System*). The APACHE III system was developed in 1991. This system is more complex, has 17 physiologic variables, and is somewhat less used. There are many other systems, including the 2nd Simplified Acute Physiology Score (SAPS II), the Mortality Prediction Model (MPM), and the Sequential Organ Failure Assessment (SOFA) score.
2009
- (Ronco et al., 2009) ⇒ Claudio Ronco, Rinaldo Bellomo, and John A. Kellum.(2009). “Critical care nephrology.” In: Elsevier Health Sciences, 2009. ISBN:978-1-4160-4252-5 http://www.us.elsevierhealth.com/critical-care-nephrology-9781416042525.html
- QUOTE: The Acute Physiology and Chronic Health Evaluation (APACHE) score was first developed in 1981 by Knaus and colleagues' using a nominal group process. This score and its offspring, APACHE II through IV, have become the most commonly used ICU survival prediction model. The purpose of the APACHE system as it was developed was not to prognosticate for individual patients but to classify groups of patients according to severity of illness. The original APACHE score was divided into two sections, a physiology score designed to measure the level of acute illness and a preadmission health status evaluation designed to determine the chronic health status of the patient. The physiology portion assessed abnormalities in 34 physiological variables over the first 32 hours of admission and awarded each a weighted score such that the higher the score, the sicker the patient. The preadmission health status portion reviewed functional status, medical attention, and presence of chronic diseases over the 6 months prior to admission and allocated patients to one of four chronic health categories from A (prior good health) to D (severe restriction of activity due to disease). A patient's APACHE classification would, therefore, consist of a number (the physiology score) and a letter (the chronic health status), for example, 33-D. In 1985, Knaus and colleagues' revised and simplified the original APACHE model to create APACHE II. APACHE II reduced the number of physiological measurements from 34 to just 12 using a multivariate comparison of the original APACHE.
1985
- (Kaus et al., 2015) ⇒ William A. Knaus, Elizabeth A. Draper, Douglas P. Wagner, and Jack E. Zimmerman. (1985) "APACHE II: a severity of disease classification system.” In: Critical care medicine 13.10 (1985) 818-829 ⇒ http://xa.yimg.com/kq/groups/16749867/1433507048/name/Critical%252BCare%252BMedicine%252B1985%252BKnaus.pdf
- QUOTE: The APACHE II classification system is a revised version of a prototype system, APACHE (acute physiology and chronic health evaluation). The basis for APACHE's development was the hypothesis that the severity of acute disease can be measured by quantifying the degree of abnormality of multiple physiologic variables. We used this approach because we believe that one of intensive care's major functions is to detect and treat life-threatening acute physiologic derangements, and that a severity classification system must be based on objective physiologic measurements and be as independent of therapy as possible. Finally, the index should be valid for a wide range of diagnoses, easy to use, and based upon data available in most hospitals.