Apache Acute Physiology And Chronic Health Evaluation

• Devised by Knaus et al, this system utilises a point score derived from the degree of abnormality of readily obtainable physiological and laboratory variables in the first 24h of ICU admission, plus extra points for age and chronic ill health.

• The summated score provides a measure of severity while the percentage risk of subsequent death can be computed from specific coefficients applied to a wide range of admission disorders (excluding burns and cardiac surgery).

• APACHE I, first described in 1981, utilised 34 physiological and biochemical variables.

• A simplified version (APACHE II) utilising just 12 variables was published in 1985 and extensively validated in a number of countries.

• A further refinement published in 1990, APACHE III, claims to improve upon the statistical predictive power by adding five new physiological variables (albumin, bilirubin, glucose, urea, urine output).

• Changing thresholds and weighting of existing variables.

• Comparing both admission and 24h scores.

• Incorporating the admission source (e.g. ward, operating theatre).

• Reassessing effects of age, chronic health and specific disease category. Wide acceptance of APACHE III may be limited as its risk stratification system is proprietary and has to be purchased.

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