Critical Care >Controversies: Scoring Systems in Critical Care

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 63–1General risk prediction scoring systems and revisions.

Scoring System (Year Introduced) Number of Variables Selection of Variables and Weights Variables Comments

Acute Physiology Chronic Health Evaluation (APACHE)

Worst acute physiology variables

within the first 32 hours + The first iteration of the APACHE
APACHE I (1981) 34 Panel of expert clinicians
preadmission chronic health status 3-6 system. No longer in use.
months prior to admission.

Worst acute physiology variables Used for a group of patients, in public

within the first 24 hours (APS score) + domain, limited number of variables,
APACHE II (1985) 12 Panel of expert clinicians
preadmission chronic health status 3-6 most frequently used system for risk
months prior to admission stratification in clinical trials

Not in public domain, proprietary,

APACHE III (1991) 17 Multiple logistic regression See above
available at cost

Most accurate for hospital mortality

Data collected within the first 24 hours
and ICU length of stay, requires
Acute physiology variables, age,
considerable data and training.
chronic health variables, ICU
Specific algorithm for mortality
Multiple logistic regression (110,518 admission diagnosis, ICU admission
APACHE IV (2006) 27 prediction after Coronary Artery
patients in 104 US ICUs) source, length of stay prior to ICU
Bypass Graft (CABG) surgery.
admission, emergency surgery,
Calculator of raw score: in public
thrombolytic therapy, FiO2,
domain. Real time validation, updated
mechanical ventilation.
probabilities: proprietary

Mortality Probability Model (MPM)

MPM I (1985) 11 Multiple logistic regression First hour and 24 hours of admission Probability of death

First 24, 48, and 72 hours of

MPM II (1993) 15 Multiple logistic regression Probability of death
admission

Worst values prior to and within 1 hour

Predicts hospital mortality and ICU
of ICU admission: Acute physiologic
length of stay. Least amount of data
variables, age, chronic health
collection, does not require a
Multiple logistic regression (124,885 variables, acute diagnoses, admission
MPM0 III (2007) 16 diagnosis at ICU admission, collected
patients in 135 ICUs—mainly US) type (medical, surgical), emergency
at lower cost and least time compared
surgery, CPR within 1 hour of ICU
to APACHE IV and SAPS III. Predicts
admission, mechanical ventilation,
ICU LOS
code status

Simplified Acute Physiology Score (SAPS)

Simple to use, for stratification, not for

SAPS I (1984) 15 Panel of expert clinicians Worst values within the first 24 hours
mortality prediction

Simple to use, most widely used in

SAPS II (1993) 17 Multiple logistic regression Worst values within the first 24 hours
Europe
 Worst values prior to and within 1 hour
of ICU admission: Acute physiologic
variables, age, chronic health Simple to use (easy and quick), no
19,577 patients in 307 ICUs from 35 variables, ICU admission diagnosis, cost, wide range of diagnosis
SAPS III (2005) 20
countries; multiple logistic regression ICU admission source, length of stay represented, worldwide population
prior to ICU admission, emergency represented
surgery, infection on admission, type
of surgery

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