Abstract
The APACHE (Acute Physiology and Chronic Health Evaluation) prognostic scoring system was developed in 1981 at the George Washington University Medical Center as a way to measure disease severity. APACHE II, introduced in 1985, was a simplified modification of the original APACHE. The APACHE II score consisted of three parts: 12 acute physiological variables, age and chronic health status. Probability of death can be derived by using the disease category and the APACHE II score. The uses of APACHE II include risk stratification to account for case mix in clinical studies, comparison of the quality of care among ICUs, and assessment of group and individual prognoses. APACHE III, a refinement of APACHE II, will be introduced in late 1990. The APACHE III data base includes 17,457 patients from a representative sample of 40 American hospitals. Additional potential uses of APACHE III include the identification of factors in the ICU which contribute to outcome and assistance in individual patient decision-making. This article reviews the development, current uses and potential applications of the APACHE system.
Résumé
L’APACHE (acute physiology and chronic health evaluation) est un système de gradation pronostique qui s’est développé en 1981 à George Washington University Medical Center afin de mesurer la sévérité de la maladie. APACHE II, introduit en 1985, fut une modification qui a simplifié l’APACHE original. LAPACHE II consiste en trois parties : 12 variables physiolo-giques aiguës, âge et état de santé chronique. La probabilité de la mortalité peut être déduite en ulilisant la catégorie de maladie et le système d’évaluation APACHE II. Les utilisations de l’APACHE II incluent la stratification du risque afin de tenir compte de l’identification des cas dans des études cliniques mixtes, la comparaison de la qualité des soins entre les unités de soins intensifs et l’évaluation des pronostics individuel et de groupe. APACHE III, un rafinement de l’APACHE II, sera introduit vers la fin des années 1990. Les données de l’APACHE III incluent 17,457 patients d’une population représentative de 40 hôpitaux américains. Les utilisations potentielles addition-nelles de l’APACHE III incluent l’identification des facteurs aux soins intensifs qui contribuent à l’issue et a l’assistance concernant les décisions sur certains patients. Cet article revoit le développement des utilisations courantes, des applications potentielles du système APACHE.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Hospital Statistics, 1988. 1989–1990 ed. Chicago: American Hospital Association.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE — acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Mcd 1981; 9: 591–7.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–29.
Zimmerman JE. APACHE III study design: analytic plan for evaluation of severity and outcome. Crit Care Med 1989; 17: S169–221.
Petty TL, Lakshminarayan S, Sahn SA et al. Intensive respiratory care unit. Review often years experience. JAMA 1975; 233: 34–7.
Zimmerman JE, Knaus WA. Outcome prediction in adult intensive care.In: Shoemaker WC, Thompson WL, Holbrook PHet al. (Eds.). Textbook of Critical Care, 2nd ed. Philadelphia: Saunders 1988; 1447–65.
Seneff MG, Knaus WA. Predicting patient outcome from intensive care: a guide to APACHE, MPM, SAPS, PRISM and other prognostic scoring systems. Journal of Intensive Care Medicine 1990; 5: 33–52.
Dellinger EP, Wertz MJ, Meakins JL et al. Surgical infection stratification system for intra-abdominal infection. Arch Surg 1985; 120: 21–9.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104: 410–8.
Knaus WA, Wagner DP, Draper EA. The value of measuring severity of disease in clinical research on acutely ill patients. Journal of Chronic Disease 1984; 37: 455–63.
Roberts DE, Dobson KE, Hall KW, Light RB. Effects of prolonged naloxone infusion in septic shock. Lancet 1988; ii: 699–702.
Driks MR, Craven DE, Celli BR et al. Nosocomial pneumonia in intubatcd patients given sucralfate as compared with antacids or histaminc type 2 blockcrs. N Engl J Mcd 1987; 317: 1376–82.
Kerver AJ, Rommes JH, Mevissen-Verhage EA et al. Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 1988; 16: 1087–93.
Bohnen JM, Mustard RA, Oxholm SE, Schouten BD. APACHE II score and abdominal sepsis. Arch Surg 1988; 123: 225–9.
Olak J, Christou NV, Stein LA, Casola G, Meakins JL. Operative vs percutaneous drainage of intra-abdominal abscesses. Arch Surg 1986; 121: 141–6.
Garcia-Sabrido JL, Tallado JM, Christou NV, Polo JR, Valdecantos F. Treatment of severe intra-abdominal sepsis and or necrotic foci by an ‘Open-Abdomen’ approach. Arch Surg 1988; 123: 152–6.
Knaus WA, Draper EA, Wagner DP. Evaluating medical-surgical ICUs.In: Parillo JE, Ayers M (Eds.). Major Issues In Critical Care Medicine. Baltimore: Williams and Wilkins 1984; 35–46.
Brown JJ, Sullivan G. Effect of ICU mortality of a full-time critical care specialist. Chest 1989; 96: 127–9.
Zimmerman JE, Knaus WA, Judson JA et al. Patient selection for intensive care: a comparison of New Zealand and United States Hospitals. Crit Care Med 1988; 16: 318–26.
Dubois RW, Brook RH, Rogers WH. Adjusted hospital death rates: a potential screen for quality of medical care. Am J Public Health 1987; 77: 1162–7.
Knaus WA, Nash DB. Predicting and evaluating patient outcomes. Ann Intern Med 1988; 109: 521–2.
McClish DK, Russo A, Franklin C et al. Profile of medical ICU vs ward patients in an acute care hospital. Crit Care Med 1985; 13: 381–6.
Henning RJ, McClish D, Daly B et al. Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care. Crit Care Med 1987; 15: 264–9.
Wagner DP, Knaus WA, Draper EA. Identification of low-risk monitor admissions to medical-surgical ICUs. Chest 1987; 92: 423–8.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in acute organ-system failure. Ann Surg 1985; 202: 685–93.
Kruse JA, Thill-Baharozian MC, Carlson RW. Comparison of clinical assessment with APACHE II for predicting mortality risk in patients admitted to a medical intensive care unit. JAMA 1988; 260: 1739–42.
Silverstein MD. Prediction instruments and clinical judgement in critical care. JAMA 1988; 260: 1758–9.
McClish DK, Powell SH. How well can physicians estimate mortality in a medical intensive care unit? Med Decis Making 1989; 9: 125–32.
Larvin M, McMahon MJ. APACHE II score for assessment and monitoring of acute pancreatitis. Lancet 1989; ii: 201–5.
Chang RW, Lee B, Jacobs S, Lee B. Accuracy of decisions to withdraw therapy in critically ill patients: clinical judgement versus a computer model. Crit Care Med 1989; 17: 1091–7.
Chang RW, Jacobs S, Lee B. Predicting outcome among ICU patients using computerised trend analysis of daily APACHE II scores corrected for organ system failure. Intensive Care Med 1988; 14: 558–66.
Sox HC, Blatt MA, Higgins MC et al. Medical Decision Making. Boston: Butterworths 1988.
Chang RW, Jacobs S, Lee B. Use of APACHE II severity of disease classification to identify intensive care unit patients who would not benefit from total parcntcral nutrition. Lancet 1986; i: 1483–6.
Dobkin JE, Cutler RE. Use of APACHE II classification to evaluate outcome of patients receiving hemodialysis in an intensive care unit. West J Med 1988; 149: 547–50.
Chang RWS. Individual outcome prediction models for intensive care units. Lancet 1989; ii: 143–6.
Wagner DP, Draper EA, Knaus WA. Chapter 5. Development of APACHE III. Crit Care Med 1989; 17: S199–203.
Shortell S, Rousseau D, Gilles R. Chapter 8. Analysis of process. Crit Care Med 1989; 17: S2I3–6.
Knaus WA, Wagner DP. Chapter 6. Individual patient decision. Crit Care Med 1989; 17: S204–9.
Zimmerman JE, Galler LH, Judson JA, Streat SJ, Trubuhovich RV. Severity stratification in life-threatening asthma. Journal of Intensive Care Medicine 1990; 5: 120–7.
Dragsted L, Jorgensen J, Jensen NH et al. Intcrhospital comparisons of patient outcome from intensive care: importance of lead-time bias. Crit Care Med 1989; 17: 418–22.
Wong DT, Tough J, Houston P. The correlation of hospital mortality to daily APACHE II scores. Clin Invest Mcd 1989; 12: B22.
Bion JF, Aitchison TC, Edlin SA, Ledingham IM. Sickness scoring and response to treatment as predictors of outcome from critical illness. Intensive Care Mcd 1988; 14: 167–72.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wong, D.T., Knaus, W.A. Predicting outcome in critical care: the current status of the APACHE prognostic scoring system. Can J Anaesth 38, 374–383 (1991). https://doi.org/10.1007/BF03007629
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03007629