B Age Points
Assign points to age as follows: Age (yrs) Points
C Chronic Health Points
If the patient has a history of severe organ system insufficiency or is immunocompromised assign points as follows:
a. for nonoperative or emergency postoperative patients – 5 points b. for elective postoperative patients – 2 points Definitions:
Organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform to the following criteria: Liver Biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of hepatic failure / encephalophathy / coma Cardiovascular Respiratory New York Heart Association Class IV Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction, i.e., unable to climb stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension (> 40 mmHg), or respiratory dependency Renal receiving chronic dialysis ? 44 0
45 – 54 2
55 – 64 3
65 – 74 5
? 75 6
Immunocompromised The patient has received therapy that suppresses resistance to infection, e.g., immunosuppression, chemotherapy, radiation, long-term or recent high doses steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g., leukemia, lymphoma, AIDS
APACHE II Score
A APS points B Age points
C Chronic health points
Total APACHE II score = A + B + C = Emergency surgery: ? Yes ? No Diagnostic category weight: Probability of Death:
Principal Diagnostic Categories Leading to ICU Admission Nonoperative patients Respiratory failure or insufficiency from: Postoperative patients Multiple trauma Admission due to chronic cardiovascular dis. Peripheral vascular surgery Heart valve surgery Craniotomy for neoplasm Renal surgery for neoplasm Renal transplant Head trauma Thoracic surgery for neoplasm Craniotomy for ICH/SDH/SAH Laminectomy and other spinal cord surgery Hemorrhagic shock GI bleeding GI surgery for neoplasm Respiratory insufficiency after surgery GI perforation/obstruction -1.684 -1.376 -1.315 -1.261 -1.245 -1.204 -1.042 -0.955 -0.802 -0.788 -0.699 -0.682 -0.617 -0.248 -0.140 0.060 Asthma/allergy -2.108 COPD -0.367 Pulmonary edema (noncardiogenic) -0.251 Postrespiratory arrest -0.168 Aspiration/poisoning/toxic -0.142 Pulmonary embolus -0.128 Infection 0 Neoplasm 0.891 Cardiovascular failure or insufficiency from: Hypertension -1.798 Rhythm disturbance -1.368 Congestive heart failure -0.434 Hemorrhagic shock/hypovolemia 0.493 Coronary artery disease -0.191 Sepsis 0.113 Postcardiac arrest 0.393 Cardiogenic shock -0.259 Dissecting thoracic/abdominal aneurysm 0.731 Trauma: Multiple trauma -1.228 Head trauma -0.517 Neurologic: Seizure disorder -0.584 ICH/SDH/SAH 0.723 Other: Drug overdose -3.353 Diabetic ketoacidosis 01.597 GI bleeding 0.334 For postoperative patients admitted to the ICU for sepsis or postarrest, use the corresponding weights for nonoperative patients. If not in one of the specific groups above, then which If not in one of the above, which major vital organ major vital organ system was the principal reason for system led to ICU admission postsurgery? admission? Metabolic/renal Respiratory Neurologic Cardiovascular Gastrointestinal -0.885 -0.890 -0.759 0.470 0.501 Neurologic Cardiovascular Respiratory Gastrointestinal Metabolic/renal -1.150 -0.797 -0.610 -0.613 -0.196 To compute predicted death rates for groups of acutely ill patients, for each individual compute the risk (R) of hospital death with the following equation; then sum the individual risks and divide by the total number of patients.
ln(R/1-R) = -3.517 + (APACHE II score x 0.146) + (0.603, only if postemergency surgery) + (Diagnostic category weight)