Key messages

• APACHE II is a useful measure of severity of disease, but mortality predictions are of limited value because they are based on treatment outcomes between 1979 and 1982.

• APACHE III measures severity of disease, and provides an updated standard or benchmark for assessing the effectiveness and efficiency of the intensive care unit.

• Estimates of patient risk can assist in decision-making for individual patients, but will never predict death or survival with 100 per cent accuracy. The APACHE system

The Acute Physiology and Chronic Health Evaluation (APACHE) system was developed to measure severity of illness for intensive care unit (ICU) patients. APACHE I was developed between 1979 and 1981 and consisted of two parts: an acute physiology score (weights 1-4), which indicated the extent of 34 potential acute physiological abnormalities, and a chronic health evaluation measured using a questionnaire which classified patients (A-D) according to their prior health status. The variables in APACHE I were selected from a review of the literature and weighted by a panel of expert clinicians. The APACHE I score correlated directly with hospital mortality, but the system was complex, required multihospital validation, and did not include probability calculations.

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