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According to the instrument creator, Dr. William Knaus, the APACHE II total score is designed as a mortality prediction tool but . It is not intended to influence the medical management or care of subjects during their ICU stay or to be calculated sequentially to show improvement or effect of interventions. A number of physiology measurements are used to calculate the APACHE II total score. The worst values recorded during the initial 24 hours in the ICU is used. Alternatively, the measurements initially recorded during the subject’s admission can be used for practical reasons. The APACHE II total score is not calculated sequentially and is not meant to show improvement or effect of interventions. The APACHE II total score is the most widely used ICU mortality prediction score. It differs from the original APACHE score in some ways; the number of physiology measurements is decreased and the weight of some of the physiology measurements is adjusted. APACHE III and APACHE IV scores were also developed but are not commonly used because their statistical method is under copyright control. The total score is not intended to be applied to specific populations such as liver failure or HIV patients and is not accurate when dealing with patients transferred from another unit or another hospital. This is known as lead time bias and is addressed in APACHE III. The APACHE II total score must be recalibrated before it can be used in a population other than the general ICU population. ICU prediction scores in general need to be periodically recalibrated to reflect changes and improvements in practice and patient demographics.

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