Hematocrit (%):
Rectal temperature:
Mean arterial pressure:
Heart rate:
Respiratory rate:
Serum sodium:
Serum K+:
Arterial pH:
(if no arterial blood gas data, use HCO3)
Serum creatinine (mg/dL):
History of severe organ insufficiency or immuno-compromised*:
Glasgow Coma Score:

Estimated risk of hospital death:

*If the patient has a history of severe organ system insufficiency or is immunocompromised as defined below, assign points as follows:

5 points for nonoperative or emergency postoperative patients 2 points for elective postoperative patients

Definitions: Organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform to the following criteria:

Liver––biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of hepatic failure/encephalopathy/coma. Cardiovascular––New York Heart Association Class IV. Respiratory––Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction (i.e., unable to climb stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension (>40 mmHg), or respirator dependency. Renal––receiving chronic dialysis. Immunocompromised––the patient has received therapy that suppresses resistance to infection (e.g., immunosuppression, chemotherapy, radiation, long term or recent high dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g., leukemia, lymphoma, AIDS).


Knaus WA Draper EA et al. APACHE II: A severity of disease classification system. Critical Care Medicine. 1985; 13 (Appendix pages 828-829). The Clinician's Ultimate Guide to Drug Therapy (www.globalrph.com)