APACHE II ("Acute Physiology and Chronic Health Evaluation II") is a severity-oI-disease

classiIication system (Knaus et al., 1985)

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, one oI several ICU scoring systems. It is applied
within 24 hours oI admission oI a patient to an intensive care unit (ICU): an integer score Irom 0
to 71 is computed based on several measurements; higher scores correspond to more severe
disease and a higher risk oI death.
Contents
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O 1 Application
O 2 Calculation
O APACHE III
O 4 See also
O 5 External links
O ReIerences
edit] Application
APACHE II was designed to measure the severity oI disease Ior adult patients admitted to
Intensive care units. The lower age bound is not speciIied in the original article, but a good limit
is to use Apache II only Ior patients aged 15 or older
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.
This scoring system is used in many ways:
O Some procedures and some medicine is only given to patients with a certain APACHE II
score
O APACHE II score can be used to describe the morbidity oI a patient when comparing the
outcome with other patients.
O Predicted mortalities are averaged Ior groups oI patients in order to speciIy the group's
morbidity.
Even though newer scoring systems, such as 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 Irom 12 routine physiological measurements, such as blood
pressure, body temperature, heart rate, etc., during the Iirst 24 hours aIter admission, inIormation
about previous health status, and some inIormation obtained at admission (such as age). The
calculation method is optimized Ior paper schemas, by using integer values and reducing the
number oI options so that data Iit on a single-sheet paper Iorm. The resulting point score should
always be interpreted in relation to the illness oI the patient.
The score is not recalculated during the stayit is by deIinition an admission score. II a patient
is discharged Irom the ICU and readmitted, a new APACHE II score is calculated.
The appendix oI the document (see reIerences) that originally described the APACHE II score,
attempts to describe how to calculate a predicted death rate Ior a patient. In order to improve the
accuracy oI this calculation oI predicted mortality, the principal diagnosis leading to ICU
admission was added as a category weight: the predicted mortality is computed based on the
patient's APACHE II score and their principal diagnosis at admission.
edit] APACHE III

This section requires expansion.
A method to compute a reIined score known as APACHE III was published in 1991. The score
was validated on the dataset Irom 17,440 adult medical/surgical intensive care unit (ICU)
admissions at 40 US hospitals. APACHE III scores range Irom 0 to 299
Applications of Trauma Severity Scoring
An accurate method Ior quantitatively summarizing injury severity has many potential
applications. The ability to predict outcome Irom trauma (ie, mortality) is perhaps the most
Iundamental use oI injury severity scoring, a use that arises Irom the patient's and the Iamily's
desires to know the prognosis. More recently, physicians suggested that injury severity scoring
can provide objective inIormation Ior end-oI-liIe decision-making and resource allocation.
Trauma mortality prediction in individual patients by any scoring system is limited and is in
general no better than good clinical judgment. ThereIore, decisions Ior individual patients should
never be based solely on a statistically derived injury severity score. However, scoring systems
can serve to estimate quantitatively the level oI acuity oI injured patients that are applied to
adjustments in hospital outcome assessments.
Sartorius et al developed a simple score Ior the prehospital triage oI trauma patients by
calculations Irom adding points Irom 4 independent variables
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: Glasgow Coma Scale (Irom -
15 points), blunt trauma (4 points), systolic arterial blood pressure (~120 mm Hg: 5 points; 0-
120 mm Hg: points), and age 0 years (5 points). This score is the Mechanism, Glasgow
Coma Scale, Age, and Arterial Pressure (MGAP) score and can be used to accurately predict in-
hospital death in trauma patients. Total scores divide patients into risk groups: low (2-29
points), intermediate (18-22 points), and high risk ( 18 points). Mortality oI patients in the
groups was 2.8, 15, and 48, respectively, in the derivation cohort, with comparable results
in the validation cohort.
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Field trauma scoring also is used to Iacilitate rational prehospital triage decisions, thereby
minimizing the time Irom injury occurrence to deIinitive management. Similarly, physicians
suggest that it can enhance appropriate use oI helicopters and timely transIer oI severely injured
patients to trauma wards. Trauma scoring also is used Ior quality assurance by allowing
evaluation oI trauma care both within and between trauma centers, a contentious and
controversial area that is likely to only increase in importance.
Perhaps the most important role Ior injury severity scoring is in trauma care research. ScientiIic
study oI the epidemiology oI trauma and trauma outcomes would not be possible otherwise.
Injury severity scoring is indispensable in stratiIying patients into comparable groups Ior
prospective clinical trials. Similarly, this technique can be used retrospectively to identiIy and
control Ior diIIerences in baseline injury severity between patient populations.
Revised Trauma Score
The Revised Trauma Score is a physiological scoring system, with high inter-rater reliability and
demonstrated accurracy in predictng death. It is scored from the first set of data obtained on the
patient, and consists of Glasgow Coma Scale, Systolic Blood Pressure and Respiratory Rate.
asgow Coma Scae
(CS)
Systoic Bood Pressure
(SBP)
Respiratory Rate
(RR)
Coded Vaue
- -2 4
-2 76- 2 3
6- -7 6- 2
- - - 1
0

RTS = 0.9368 CS + 0.7326 SBP + 0.2908 RR
Values for the RTS are in the range to 7.. The RTS is heavily weighted towards the Glasgow
Coma Scale to compensate for major head injury without multisystem injury or major physiological
changes. A threshold of RTS < has been proposed to identify those patients who should be treated
in a trauma centre, although this value may be somewhat low.
The RTS correlates well with the probability of survival :