Table 2224.

ACUTE PHYSIOLOGIC ASSESSMENT AND CHRONIC HEALTH EVALUATION (APACHE) II SCORING SYSTEM*
PHYSIOLOGIC VARIABLE 1 2 3 4 POINT SCORE +4 +3 +2 +1 0 +1 +2 +3 +4

6 7 8 9

10 11 12

Temperature, 41 3940.9 38.538.9 3638.4 3435.9 3233.9 3031.9 29.9 core (C) 49 Mean arterial 160 130159 110129 70109 5069 pressure (mm Hg) 39 Heart rate 180 140179 110139 70109 5569 4054 5 Respiratory 50 3549 2534 1224 1011 69 rate (nonventilated or ventilated) Oxygenation: 500 350499 200349 < 200 a) FIO2 0.5: use A-aDO2 b) FIO2 < 0.5: < 55 > 70 6170 5560 use PaO2 (mm Hg) Arterial pH 7.7 7.67.69 7.57.59 7.337.49 7.257.32 7.157.24 < 7.15 Serum Na 180 160179 155159 150154 130149 120129 111119 110 (mmol/L) < 2.5 Serum K 7 66.9 5.55.9 3.55.4 33.4 2.52.9 (mmol/L) Serum creati 3.5 23.4 1.51.9 0.61.4 < 0.6 nine (mg/dL); double point score for acute renal failure < 20 Hct (%) 60 5059.9 4649.9 3045.9 2029.9 <1 WBC 40 2039.9 1519.9 314.9 12.9 (in 1000s) Score = 15 minus actual GCS (see Table 1744 on p. 1661) Glasgow coma score (GCS)

Acute physiology score is the sum of the 12 individual variable points. Add 0 points for age < 44; 2 points, 4554 yr; 3 points, 5564 yr; 5 points, 6574 yr; 6 points 75 yr. Add chronic health status points: 2 points for elective postoperative patient with immunocompromise or history of severe organ insufficiency; 5 points for nonoperative patient or emergency postoperative patient with immunocompromise or severe organ insufficiency. (13) Serum HCO3 (venous mmol/L) 52 4151.9 3240.9 2231.9 1821.9 1517.9 < 15

*APACHE II score = acute physiology score + age points + chronic health points. Minimum score = 0; maximum score = 71. Increasing score is associated with increasing risk of hospital death. Choose worst value in the past 24 h. Chronic health status: Organ insufficiency (eg, hepatic, cardiovascular, renal, pulmonary) or immunocompromised state must have preceded current admission. This variable is optional; use only if no ABGs are available. A-a DO2 = alveolararterial oxygen gradient; FIO2 = fractional inspired O2. Adapted from Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: A severity of disease classification system. Critical Care Medicine 13:818829, 1985.
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