Critical Care Scoring Systems: Approach to the Critically Ill Patient: Merck Manual Professional

Critical Care Medicine

Approach to the Critically Ill Patient

Critical Care Scoring Systems

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Critical Care Scoring Systems

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Several scoring systems have been developed to grade the severity of illness in critically ill patients. These systems are moderately accurate in predicting individual survival. However, these systems are more valuable for monitoring quality of care and for conducting research studies because they allow comparison of outcomes among groups of critically ill patients with similar illness severity.

The most common system is the 2nd version of the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score introduced in 1985. It generates a point score ranging from 0 to 71 based on 12 physiologic variables, age, and underlying health (see Table 4: Approach to the Critically Ill Patient: Acute Physiologic Assessment and Chronic Health Evaluation (Apache) II Scoring System*). The APACHE III system was developed in 1991. This system is more complex, has 17 physiologic variables, and is somewhat less used. There are many other systems, including the 2nd Simplified Acute Physiology Score (SAPS II) and several mortality probability models.