APACHE versus SOFA scoring systems

OVERVIEW

  • APACHE and SOFA are scoring systems that are commonly used in intensive care
  • APACHE = Acute Physiology, Age and Chronic Health Evaluation (I-IV)
  • SOFA = Sequential Organ Failure Assessment 

APACHE VERSUS SOFA

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FeatureAPACHESOFA
BasisThree factors that influence outcome in critically ill patients
  1. chronic background disease
  2. patient reserve
  3. severity of acute illness
Degree of organ dysfunction is related to acute illness(initially based on sepsis related organ dysfunction but later validated for organ dysfunction not related to sepsis)
ScorePhysiological variable, chronic health conditions, emergency / elective admissions, and post-operative / non-operative admissionsDefined score (1-4) for each of six organ systems
  1. Respiratory
  2. CVS
  3. CNS
  4. renal
  5. Coagulation
  6. Liver
Scoring durationBased on the most abnormal measurements in the first 24 hours of ICU stayDaily scoring of individual and composite scores possible during course of ICU stay
Population outcome comparisonStandardized mortality ratios can be used for large patient populationsNo predicted mortality algorithm.
In general, higher SOFA score is associated with worse outcome.Treatment effects on SOFA
Individual patient outcomesNot possible to predict individual patient outcome or response to therapyResponse of organ dysfunction to therapy can be followed over time

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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