Acute Physiology and Chronic Health Evaluation- (APACHE) (1981)

ICU score originally has two components

• Chronic health evaluation (CHE)
• Acute Physiology Score (APS)

Chronic health evaluation (CHE)

Incorporates the influence of comorbid conditions (e.g. diabetes mellitus, cirrhosis) and

Acute Physiology Score (APS)

Weighted variables representing the major physiological systems, including neurological, cardiovascular, respiratory, renal, gastrointestinal, metabolic and haematological variables. The data that are the most abnormal during the first 24 h are used.

The APACHE II (1985) revision restricted the number of comorbid conditions and APS variables from 34 to 12, making the system popular despite its limitations.

Limitations:

• The GCS, which comprises a powerful predictive component of the APS, was not intended to reflect extracranial injuries. Being from a relatively younger population, comorbidity is unusual in these patients and there is potential for lead-time bias.

• APACHE II underestimates the likelihood of death in patients who are transferred to the ICU after relative stabilisation, as it uses ICU data only and does not account for prior treatment/ resuscitation

• APACHE II is inferior to the TRISS in predicting mortality in injured patients. Poor performance has been attributed largely to the absence of an anatomical component in the APACHE system.

• APACHE II was developed in mainly non-trauma ICU patients who had different clinical problems. In general terms, it is a score that provides guidance about the clinical course of a patient.

The most recent version APACHE III (1991) was designed to address many of these issues. The most important modifications were the inclusion of 17 variables; limiting comorbid conditions to those affecting immune function; disease-specific equations, including multiple trauma; distinguishing between head and non-head trauma; and accounting for potential lead-time bias.

Practitioners do not widely accept APACHE III, partly because it is proprietary and expensive. In addition, its accuracy needs to be convincingly validated in patients with trauma.

Predicting outcome after multiple trauma: which scoring system?; Injury, Volume 35, Issue 4, April 2004, Pages 347-358; M. N. Chawda , F. Hildebrand , H. C. Pape and P. V. Giannoudis

http://www.sfar.org/scores2/apache22.html - Apache calculator

Last updated 11/09/2015