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clinmed/2003090011v1 (February 24, 2004)
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Simplifying APACHE II Scoring using PDA’s

Ian Galloway, Marry-Gordon Mackenzie, Andrew McIvor, and Paul Hernandez

Rationale: The APACHE II scoring system is one of the most commonly used indices for measuring acute illness severity. This index has become a standard tool for measuring outcome predictions, monitoring ICU patients for quality assurance, and identifying cohort groups in research. Despite the benefits of the APACHE II scoring system, previous research has documented barriers to its accurate recording. Even after the implementation of guidelines and training programs the literature recognized calculation error as one of the persistent sources of variability. To decrease incidence of calculation error and simplify the task of APACHE II scoring, we developed a Palm operating system personnel digital assistant application, APACHE II software (A2S). We validated the accuracy of the A2S to demonstrate the potential clinical utility of this application.

Method: Retrospective review of 100 randomly selected APACHE II scores from a previous research project were recalculated using the A2S and verified by using a standard paper-scoring sheet. An expert scorer compiled the original physiological variables and calculated the initial APACHE II scores.

Results: Accuracy of the A2S using the original physiological variables was found to be 100%. Analysis revealed that mathematical error and inaccurate weighting on the part of the expert scorer accounted for the 19% (n = 19) variability. Weighting of the variables was the greatest source of error 78% (n = 15), summing of the variables was responsible for 11% (n = 2) and the remaining 11% was due to pre-calculation errors.

Conclusion: The A2S may help decrease the incidence of computational errors and improve consistency among scorers when compared with a manually scored APACHE II using a standard paper-scoring sheet.