ICU Scores:

Acute Physiology & Chronic Health Evaluation (APACHE IV):

An exception is the use of APACHE II scoring in the severity assessment and stratification of sepsis patients as an indication for determining the appropriateness of the use of Activated Protein C for patients with severe sepsis.  The groundbreaking work in this area was performed using the APACHE  database (APACHE’s own research), and other research a clinical trials (such as by Eli Lilly) have utilized APACHE II scoring in conjunction with contemporary patient groups.

Please be aware that the APACHE II score, while still appropriate for the severity stratification of sepsis patients, does not extend to the mortality predictions based upon that score.  Those predictions were originally calculated in 1984, and no recalibration on national databases have been done since that time

APACHE ® IV Calculator APACHE is a registered trademark of Cerner Corporation, Kansas City, Missouri, USA Non-CABG Patients only Enter the lowest and the highest values for the physiologic parameter Use the worse values during the 24 hour period Select the Unit: Conventional UnitsInternational Units (SI) Lowest Highest Lowest Highest Temperature : °F°C Sodium (mmol/L) Systolic B/P (mm Hg): Glucose Diastolic B/P (mm Hg): Creatinine Heart Rate (/m): BUN Respiratory Rate (/m): Urine Output (ml/24hrs) Altitude above sea level: FeetMeter Albumin Fio2 (%): Bilirubin PH: HCT (%) PO2: WBC (x103/ mm3 ) PCO2: Glasgow Coma Score Check only if unable to obtain GCS due to Meds, anesthesia, or sedation Eye Opening Verbal Response Motor Response spontaneous to speech to pain absent converses & oriented converses & dsoriented iappropriate incomprehensible absent obeys localizes pain withdraws (flexion) decorticate (flexion) rigidity decerebrate (extension) rigidity absent Glasgow Coma Score= Age (years) Chronic Health Condition CRF/HD (used for APS) Metastatic Cancer AIDS Leukemia/Multiple Myeloma Hepatic Failure Immunosuppression Lymphoma Cirrhosis ICU Admission Information Admitted from: Other Floor OR/PACU Another Hospital Pre ICU LOS (days) Emergency Surgery Readmission Ventilated at any time (first 24 hrs) Admitting Diagnosis None/Not Available Abdomen only trauma Abdomen only trauma, surgery for Abdomen/extremity trauma Abdomen/extremity trauma, surgery for Abdomen/face trauma Abdomen/face trauma, surgery for Abdomen/multiple trauma Abdomen/multiple trauma, surgery for Abdomen/pelvis trauma Abdomen/pelvis trauma, surgery for Abdomen/spinal trauma Abdomen/spinal trauma, surgery for Ablation or mapping of cardiac conduction pathway Abscess, neurologic Abscess/infection-cranial, surgery for Acid-base electrolyte disturbance Addisons disease Adrenal neoplasm (including pheochromocytoma) Adrenalectomy Alcohol withdrawal ALL OTHER NON_OPERATIVE TRANSPLANTS ALL OTHER POST-OPERATIVE TRANSPLANTS Amputation (non-traumatic) Amyotrophic lateral sclerosis Anaphylaxis Anastomosis, vascular Anemia Aneurysm repair, ventricular Aneurysm, abdominal aortic Aneurysm, abdominal aortic; with dissection Aneurysm, abdominal aortic; with rupture Aneurysm, dissecting aortic Aneurysm, thoracic aortic Aneurysm, thoracic aortic; with dissection Aneurysm, thoracic aortic; with rupture Aneurysm/pseudoaneurysm, other Aneurysms, repair of other (except ventricular) Angina, stable (asymp or stable pattern of symptoms w/meds) Angina, unstable (angina interferes w/quality of life or meds are tolerated poorly) Aortic and Mitral valve replacement Aortic valve replacement (isolated) Apnea, sleep Apnea-sleep; surgery for (i.e. UPPP -uvulopalatopharyngoplasty) Appendectomy ARDS-adult respiratory distress syndrome, non-cardiogenic pulmonary edema Arrest, respiratory (without cardiac arrest) Arteriovenous malformation, surgery for Arthritis, rheumatoid Arthritis, septic Asthma Atelectasis Atrial Septal Defect (ASD) Repair Biopsy, brain Biopsy, open lung Bladder repair for perforation/rupture Bleeding, GI from esophageal varices/portal hpertension Bleeding, GI-location unknown Bleeding, lower GI Bleeding, upper GI Bleeding-lower GI, surgery for Bleeding-other GI, surgery for Bleeding-upper GI, surgery for Bleeding-variceal, surgery for (excluding vascular shunting) Blood transfusion reaction Bullectomy Burr hole placement Cancer oral/sinus, surgery for Cancer, colon/rectal Cancer, esophageal Cancer, laryngeal Cancer, lung Cancer, oral Cancer, other GI Cancer, pancreatic Cancer, stomach Cancer, tracheal Cancer-colon/rectal, surgery for (including abdominoperineal resections) Cancer-esophageal, surgery for (abdominal approach) Cancer-laryngeal/tracheal, surgery for Cancer-other GI tract, surgery for (i.e. hepatoma, gallbladder etc.) Cancer-small intestinal, surgery for Cancer-stomach, surgery for CAPD catheter insertion Cardiac arrest (with or without respiratory arrest) Cardiomyopathy Cardiovascular medical, other Cardiovascular surgery, other Cellulitis and localized soft tissue infections Cellulitis and localized soft tissue infections, surgery for Cerebrospinal fluid leak, surgery for Cesarean section Chest pain, atypical (noncardiac chest pain) Chest pain, epigastric Chest pain, musculoskeletal Chest pain, respiratory Chest pain, unknown origin Chest/abdomen trauma Chest/abdomen trauma, surgery for Chest/extremity trauma Chest/extremity trauma, surgery for Chest/face trauma Chest/face trauma, surgery for Chest/multiple trauma Chest/multiple trauma, surgery for Chest/pelvis trauma Chest/pelvis trauma, surgery for Chest/spinal trauma Chest/spinal trauma, surgery for Chest/thorax only trauma Chest/thorax only trauma, surgery for CHF, congestive heart failure Cholangitis Cholecystectomy/cholangitis, surgery for (gallbladder removal) Coagulopathy Coma/change in level of consciousness Complications of prev. peripheral vasc. surgery Complications of previous GI surgery; Complications of previous open heart Complications of previous open-heart surgery Complications of previous spinal cord surgery, surgery for Congenital Defect Repair (Other) Connective tissue disease (mixed) Contusion, myocardial (include R/O) Cosmetic surgery (all) Cranial nerve, decompression/ligation Cranioplasty and complications from previous craniotomies CVA, cerebrovascular accident/stroke Cyst, ruptured ovarian Cystectomy (other reasons) Cystectomy for neoplasm Defibrillator, automatic implantable cardiac; insertion of Devices for spine fracture/dislocation Diabetic hyperglycemic hyperosmolar nonketotic coma (HHNC) Diabetic ketoacidosis Dilatation (with general anesthesia) Dilatation (without general anesthesia) Diverticular disease Diverticular disease, surgery for Drug withdrawal Ectopic pregnancy (all) Efffusion, pericardial Effusions, pleural Embolectomy (with general anesthesia) Embolectomy (without general anesthesia) Embolus, pulmonary Emphysema/bronchitis Encephalitis Encephalopathies (excluding hepatic) Encephalopathy, hepatic Endarterectomy (other vessels) Endarterectomy, carotid Endocarditis Esophageal surgery, other Exenteration, pelvic -male Exenteration, pelvic-female Extremity only trauma Extremity only trauma, surgery for Extremity/face trauma Extremity/face trauma, surgery for Extremity/multiple trauma Extremity/multiple trauma, surgery for Face only trauma Face only trauma, surgery for Face/multiple trauma Face/multiple trauma, surgery for Facial surgery (if related to trauma, see Trauma) Fistula/abscess, surgery for (not inflammatory bowel disease) Fracture-pathological, non-union, non-traumatic, Fusion-spinal/Harrington rods Gastrostomy Genitourinary medical, other Genitourinary surgery, other GI Abscess/cyst GI Abscess/cyst-primary, surgery for GI medical, other GI Obstruction GI Obstruction, surgery for (including lysis of adhesions) GI Perforation/rupture GI Perforation/rupture, surgery for GI surgery, other GI Vascular insufficiency GI Vascular ischemia, surgery for (resection) Graft for dialysis, insertion of Graft, aorto-femoral bypass Graft, aorto-iliac bypass Graft, femoral-femoral bypass Graft, femoral-popliteal bypass Grafting, skin (all) Grafts, all other bypass (except renal) Grafts, all renal bypass Grafts, removal of infected vascular Guillian-Barre syndrome Head (CNS) only trauma Head (CNS) only trauma, surgery for Head/abdomen trauma Head/abdomen trauma, surgery for Head/chest trauma Head/chest trauma, surgery for Head/extremity trauma Head/extremity trauma, surgery for Head/face trauma Head/face trauma, surgery for Head/multiple trauma Head/multiple trauma, surgery for Head/pelvis trauma Head/pelvis trauma, surgery for Head/spinal trauma Head/spinal trauma, surgery for Heat exhaustion/stroke Hematologic medical, other Hematologic surgery, other Hematoma, epidural Hematoma, epidural, surgery for Hematoma, subdural Hematoma, subdural, surgery for Hematomas Hemorrhage (for gastrointestinal bleeding GI-see GI system) Hemorrhage, intra/retroperitoneal Hemorrhage, postpartum (female only) Hemorrhage/hematoma, intracranial Hemorrhage/hematoma-intracranial, surgery for Hemorrhage/hemoptysis, pulmonary Hemothorax Hepatic failure, acute Hepato-renal syndrome Hernia-hiatal, esophageal surgery for Herniorrhaphy Hip replacement, total (non-traumatic) Hydrocephalus, obstructive Hypertension, uncontrolled (for cerebrovascular Hypertension-pulmonary, primary/idiopathic Hyperthermia Hyperthyroid storm/crisis Hypoglycemia Hypothermia Hypothyroid/myxedema Hypovolemia (including dehydration. Do NOT include shock states.) Hysterectomy for cancer with or without lymph node dissection Hysterectomy for other benign neoplasm/fibroids Infarction, acute myocardial (MI), ANTERIOR Infarction, acute myocardial (MI), INFEROLATERAL Infarction, acute myocardial (MI), NON Q Wave Infarction, acute myocardial (MI), none of the above Infection/abscess, other surgery for Inflammatory bowel disease Inflammatory bowel disease, surgery for Kidney transplant Kidney transplant Knee replacement, total (non-traumatic) Laminectomy/spinal cord decompression (excluding malignancies) Leukemia, acute lymphocytic Leukemia, acute myelocytic Leukemia, chronic lymphocytic Leukemia, chronic myelocytic Leukemia, other Liver transplant Liver transplant Lupus, systemic Lymph node dissection, pelvic or retroperitoneal(female) Lymph node dissection, pelvic or retroperitoneal(male) Lymphoma Hodgkins, surgery for (including staging) Lymphoma, Hodgkins Lymphoma, non-Hodgkins Lymphoma, non-Hodgkins; surgery for (including staging) Mastectomy (all) Meningitis Metabolic/endocrine medical, other Metabolic/endocrine surgery, other MI admitted > 24hrs after onset of ischemia Mitral valve repair Mitral valve replacement Monitoring, hemodynamic (pre-operative evaluation) Musculoskeletal medical, other Myasthenia gravis Myositis, viral Near drowning accident Neoplasm, neurologic Neoplasm-cranial, surgery for (excluding transphenoidal) Neoplasm-spinal cord surgery or other related procedures Nephrectomy (other reasons) Nephrectomy for neoplasm Neurologic medical, other Neurologic surgery, other Neuromuscular medical, other Neutropenia Nontraumatic coma due to anoxia/ischemia Obesity-morbid, surgery for Obstruction due to neoplasm ,surgery for; (with or without ileal-conduit) Obstruction due to nephrolithiasis, surgery for (with or without ileal-conduit) Obstruction/other, surgery for (with or without ileal-conduit) Obstruction-airway (i.e. acute epiglottitis, post-extubation edema, foreign body, etc.) Oophorectomy with/without salpingectomy with/without lymph node dissection Orchiectomy with/without pelvic lymph node dissection Orthopedic surgery, other Overdose, alcohols (bethanol, methanol, ethylene glycol) Overdose, analgesic (aspirin, acetaminophen) Overdose, antidepressants (cyclic, lithium) Overdose, other toxin, poison or drug Overdose, sedatives, hypnotics, antipsychotics, benzodiazepines Overdose, street drugs (opiates, cocaine, amphetamine) Pancreatitis Pancreatitis, surgery for Pancytopenia Papillary muscle rupture Parathyroidectomy Pelvic relaxation (cystocele, rectocele, etc.) Pelvis/extremity trauma Pelvis/extremity trauma, surgery for Pelvis/face trauma Pelvis/face trauma, surgery for Pelvis/hip only trauma Pelvis/hip only trauma,surgery for Pelvis/multiple trauma Pelvis/multiple trauma, surgery for Pelvis/spinal trauma Pelvis/spinal trauma, surgery for Pericardial effusion/tamponade Pericardiectomy (total/subtotal) Pericarditis Peritoneal lavage Peritonitis Peritonitis, surgery for Pneumonia, aspiration Pneumonia, bacterial Pneumonia, fungal Pneumonia, other Pneumonia, parasitic (i.e. Pneumocystis pneumonia) Pneumonia, viral Pneumothorax Poisoning, carbon monoxide, arsenic, cyanide Pre-eclampsia/eclampsia (female only) Prostatectomy, suprapubic; for benign prostatic hypertrophy Prostatectomy, suprapubic; for cancer Pulmonary valve surgery Renal bleeding Renal failure, acute Renal infection/abscess Renal neoplasm, cancer Renal obstruction Respiratory- medical, other Respiratory surgery, other Restrictive lung disease (i.e. sarcoidosis, pulmonary fibrosis) Rhabdomyolysis Rhythm disturbance (atrial, supraventricular) Rhythm disturbance (conduction defect) Rhythm disturbance (ventricular) Scleroderma Seizures (primary-no structural brain disease) Seizures-intractable, surgery for Sepsis, cutaneous/soft tissue Sepsis, GI Sepsis, gynecologic Sepsis, other Sepsis, pulmonary Sepsis, renal/UTI (including bladder) Sepsis, unknown Shock, cardiogenic Shunt, peritoneal-venous;surgery for Shunt-portosystemic, surgery for Shunts and revisions Sickle cell crisis Skin surgery, other Smoke inhalation Spinal cord only trauma Spinal cord only trauma, surgery for Spinal cord sugery, other Spinal/extremity trauma Spinal/extremity trauma, surgery for Spinal/face trauma Spinal/face trauma, surgery for Spinal/multiple trauma Spinal/multiple trauma, surgery for Splenectomy Stereotactic procedure Subarachnoid hemorrhage/arteriovenous malformation Subarachnoid hemorrhage/intracranial aneurysm Subarachnoid hemorrhage/intracranial aneurysm, surgery for Sympathectomy Tamponade, pericardial Thoracotomy for benign tumor (i.e. mediastinal chest wall mass, thymectomy Thoracotomy for bronchopleural fistula Thoracotomy for esophageal cancer Thoracotomy for lung cancer Thoracotomy for lung reduction Thoracotomy for other malignancy in chest Thoracotomy for other reasons Thoracotomy for pleural disease Thoracotomy for thoracic/respiratory infection Thrombectomy (with general anesthesia) Thrombectomy (without general anesthesia) Thrombocytopenia Thrombosis, vascular (deep vein) Thrombus,arterial Thyroid neoplasm Thyroidectomy Thyroidectomy and parathyroidectomy Toxicity, drug (i.e., beta blockers, calcium channel blockers, etc.) Tracheostomy Transphenoidal surgery Trauma medical, other Trauma surgery, other Tricuspid valve surgery Tumor removal, intracardiac TURP, transurethral prostate resection for benign prostatic hypertrophy TURP, transurethral prostate resection for cancer Ulcer disease, peptic Vascular medical, other Vascular surgery, other Vasculitis Vena cava clipping Vena cava filter insertion Ventricular Septal Defect (VSD) Repair Ventriculostomy Weaning from mechanical ventilation (transfer from other unit or hospital only) Whipple-surgery for pancreatic cancer If Dx Acute MI: Thrombolytic Therapy: APACHE IV Score  APS Score Logit APACHE Disease Mapping Code Predicted Mortality Rate Predicted ICU LOS Programmed by Mazen Kherallah, MD, FCCP