Analysis of APACHE II Score to Decide Step Down of Patients from Intensive Care Unit

Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring classifies diseases according to their severity. It is a widely used intensive care unit (ICU) scoring system, ranging from 0 to 71 with a greater score meaning severe disease, increased risk of dying, higher ICU readmission, and post-ICU mortality.

A recent study published in the Journal of the associations of Physician of India (JAPI) found the association of admission and discharge APACHE II scores with the mortality rates, duration of ICU stay, and the decision to shift out of the patients from the ICU.

This was a hospital-based retrospective study in which APACHE II scoring was done for all the 121 admitted patients at admission (within 24 hours) and exited from the ICU.

It was found that a percentage of 75 of the patients had an ICU stay of fewer than 6 days, 17% had an ICU stay of 7–10 days, and 20% had an ICU stay of more than 10 days. Also, 38% of the participants had diabetes, 32% had sepsis, 28% were hypertensive, 28% were coronary artery disease patients, and 27% had cerebrovascular accidents.

The mortality rate was 45.5% in the present study. In short, it was hence concluded that the APACHE II is a comprehensive scoring system that accurately helps in predicting the severity of disease and, ultimately, ICU mortality. Patients with lower APACHE scores may be considered for an early shift to step-down units. So, this will decrease healthcare costs and ensure judicious use of resources.

Reference: Mayank Kapoor, Minakshi Dhar, Kavitha N, Birata Deobarma "Analysis of APACHE II Score to Decide Step Down of Patients from Intensive Care Unit: A Retrospective Study from a Tertiary Care Hospital"; Volume Issue:70, JAPI.