APACHE II

Regarding the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system, which one of the following statements is TRUE?

a) There are 15 physiological variables incorporated within the APACHE II scoring

system

b) The maximum number of age points that can be assigned is ten

c) A similar patient will score fewer chronic health points if they are a non-operative

critical care admission than if they are admitted following elective surgery

d) Points for the Glasgow Coma Score (GCS) are calculated by subtracting the actual

GCS from 15

e) The scores for the physiological variables are obtained by recording the most

abnormal variable in each category within the first 12 hours of admission to the

critical care unit

Answer: d

Explanation

The APACHE II scoring system remains the most widely used intensive care scoring

system, in part due to the slightly superior APACHE III scoring system’s predictive

equations being commercially protected. First described in 1985, APACHE II gives a

score (maximum 71) that represents the summation of points awarded for 12 physiological

variables, age and chronic health. The physiological variables examined are

temperature, mean arterial pressure, heart rate, respiratory rate, oxygenation, arterial

pH, serum sodium, serum potassium, serum creatinine, white cell count, GCS and

haemocrit. The number of points awarded represents the most abnormal value for each

physiological variable within the first 24 hours following intensive care unit admission.

Ten of the physiological variables score a maximum of four points each. Creatinine

scores a maximum of four or eight depending on whether the patient is in acute renal

failure. The score for the GCS is calculated by subtracting the actual GCS from 15. If a

patient leaves the intensive care unit and is then readmitted a new APACHE II score

must be calculated. The maximum number of points scored for age is six if the patient is

≥75 years old. Chronic health points are awarded if the patient has a history of severe

organ system insufficiency or is immunocompromised. The definitions of organ insufficiency

cover the cardiovascular, hepatic and renal systems. Five points are awarded

if severe organ insufficiency or an immunocompromised state is present and the

patient is admitted for a non-operative reason or following emergency surgery, and

two points for elective postoperative patients.