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The APACHE II total score is designed as a mortality prediction tool. It is not intended to influence the medical management or care of patients during their ICU stay or to be calculated sequentially to show improvement or effect of interventions. The worst values recorded during the initial 24 hours in the ICU are recommended to be used in calculation of the total score but the measurements initially recorded during the patient’s admission can be used for practical reasons. 

Although the APACHE II Discuss total score is the most widely used ICU mortality prediction score, it has a number of limitations and shortcomings. 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. Be sure to discuss the use of this instrument with the appropriate regulatory authorities.

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