Abstract
Medical care has evolved over the decades. Intensive care unit (ICU) care is the backbone for the improvement in the outcome parameters of patients across all specialties of medicine and surgery. Scoring systems are one of the widely used tools in medical practice to diagnose, stage, treat, and prognosticate patients. They help in deciding the nature and degree of intervention that is best for the patient. The acceptance of newer methods and technologies into the ICU is based on the results of statistically sound clinical studies. Many of these clinical studies will not be possible without the use of these scoring systems for sample selection and also to evaluate outcomes. So, the scoring systems are part and parcel of the ICU setup, and they have become inevitable in the present-day medical care.
Acute Physiological and Chronic Health Evaluation Index II (APACHE II) score is one of the widely used scoring systems in ICUs across the world. It has evolved from the APACHE I score and further modified into APACHE III and APACHE IV. One must be aware of the various pitfalls while calculating the APACHE II score and it uses. Apart from the APACHE II score, other scoring systems like Simplified Acute Physiological Score, Mortality Prediction Model, Pediatric Index of Mortality, Sequential Organ Failure Assessment score, etc. are used. In the setting of trauma, several scoring systems are used such as Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Revised Injury Severity Score (TRISS), Penetrating Abdominal Trauma Index (PATI), etc. One must also be aware of how to choose a scoring system. Use of preprinted charts and online calculators in smart phones will make the calculation process easy. One must be wise enough to interpret the data from scoring systems to make clinical decisions as no scoring system is 100 percent perfect.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- APACHE:
-
Acute Physiological and Chronic Health Evaluation Index
- AUROC:
-
Area under the ROC curve
- GCS:
-
Glasgow Coma Score
- ICU:
-
Intensive care unit
- ISS:
-
Injury Severity Score
- MPM:
-
Mortality Prediction Model
- PATI:
-
Penetrating Abdominal Trauma Index
- PIM:
-
Pediatric Index of Mortality
- ROC:
-
Receiver operating characteristic
- RTS:
-
Revised Trauma Score
- SAPS:
-
Simplified Acute Physiological Score
- SIRS:
-
Systemic Inflammatory Response Syndrome
- SMR:
-
Standardized morality ratio
- SOFA:
-
Sepsis-related Organ Failure Assessment
- TRISS:
-
Trauma Revised Injury Severity Score
References
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55. https://doi.org/10.1378/chest.101.6.1644.
Chhangani NP, Amandeep M, Choudhary S, Gupta V, Goyal V. Role of acute physiology and chronic health evaluation II scoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit. Indian J Crit Care Med. 2015;19(8):462–5. https://doi.org/10.4103/0972-5229.162463.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327. https://doi.org/10.1097/01.CCM.0000298158.12101.41.
Falcão ALE, Barros AGA, Bezerra AAM, Ferreira NL, Logato CM, Silva FP, et al. The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis. Ann Intensive Care. 2019;9(1):18. https://doi.org/10.1186/s13613-019-0488-9.
Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Pediatric index of mortality 2 score as an outcome predictor in pediatric intensive care unit in India. Indian J Crit Care Med. 2013;17(5):288–91. https://doi.org/10.4103/0972-5229.120320.
Grant CA, Dempsey GA, Lowe D, Brown JS, Vaughan ED, Rogers SN. APACHE II scoring for the prediction of immediate surgical complications in head and neck cancer patients. Plast Reconstr Surg. 2007;119(6):1751–8. https://doi.org/10.1097/01.prs.0000259038.36210.f8.
Ho KM, Dobb GJ, Knuiman M, Finn J, Lee KY, Webb SA. A comparison of admission and worst 24-hour acute physiology and chronic health evaluation II scores in predicting hospital mortality: a retrospective cohort study. Crit Care. 2006;10(1):R4. https://doi.org/10.1186/cc3913.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619–36. https://doi.org/10.1378/chest.100.6.1619.
Koch C, Edinger F, Fischer T, Brenck F, Hecker A, Katzer C, et al. Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients. World J Emerg Surg. 2020;15(1):63. https://doi.org/10.1186/s13017-020-00343-y.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/north American multicenter study. JAMA. 1993;270(24):2957–63. https://doi.org/10.1001/jama.270.24.2957.
Novac M, Dragoescu A, Stanculescu A, Duca L, Cernea D. The predictive value of scores used in intensive care unit for burn patients prognostic. Curr Health Sci J. 2014;40(4):253–60. https://doi.org/10.12865/CHSJ.40.04.04.
Polderman KH, Girbes AR, Thijs LG, Strack van Schijndel RJ. Accuracy and reliability of APACHE II scoring in two intensive care units problems and pitfalls in the use of APACHE II and suggestions for improvement. Anaesthesia. 2001;56(1):47–50. https://doi.org/10.1046/j.1365-2044.2001.01763.x.
Saneesh PS, Garga UC, Gupta AK, Yelamanchi R. Role of multi-detector computed tomography in severity assessment of cases of acute pancreatitis. Wien Klin Wochenschr. 2021;133(13–14):654–60. https://doi.org/10.1007/s00508-021-01870-7.
Sedloň P, Kameník L, Škvařil J, Malý M, Táborský M, Zavoral M. Comparison of the accuracy and correctness of mortality estimates for intensive care unit patients in internal clinics of the Czech Republic using APACHE II, APACHE IV, SAPS 3 and MPMoIII models. Med Glas (Zenica). 2016;13(2):82–9. https://doi.org/10.17392/860-16.
Sekulic AD, Trpkovic SV, Pavlovic AP, Marinkovic OM, Ilic AN. Scoring Systems in Assessing Survival of critically ill ICU patients. Med Sci Monit. 2015;21:2621–9. https://doi.org/10.12659/MSM.894153.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762–74. https://doi.org/10.1001/jama.2016.0288.
Suka M, Yoshida K, Takezawa J. Association between APACHE II score and nosocomial infections in intensive care unit patients: a multicenter cohort study. Environ Health Prev Med. 2004;9(6):262–5. https://doi.org/10.1007/BF02898140.
Vickers AJ. Decision analysis for the evaluation of diagnostic tests, prediction models and molecular markers. Am Stat. 2008;62(4):314–20. https://doi.org/10.1198/000313008X370302. PMID: 19132141; PMCID: PMC2614687
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800. https://doi.org/10.1097/00003246-199811000-00016.
Wagner DP, Draper EA. Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement. Health Care Financ Rev 1984;Suppl(Suppl):91–105. PMID: 10311080;
Yelamanchi R, Gupta N, Durga CK, Korpal M. Comparative study between P- POSSUM and Apache II scores in predicting outcomes of perforation peritonitis: prospective observational cohort study. Int J Surg. 2020;83:3–7. https://doi.org/10.1016/j.ijsu.2020.09.006.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 Springer Nature Switzerland AG
About this entry
Cite this entry
Yelamanchi, R. (2023). The APACHE II Scoring Systems and the ICU. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Biomarkers in Trauma, Injury and Critical Care. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Cham. https://doi.org/10.1007/978-3-031-07395-3_52
Download citation
DOI: https://doi.org/10.1007/978-3-031-07395-3_52
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-07394-6
Online ISBN: 978-3-031-07395-3
eBook Packages: Biomedical and Life SciencesReference Module Biomedical and Life Sciences