Apfel Score for Postoperative Nausea and Vomiting

Predicts risk of postoperative nausea and vomiting (PONV) in patients undergoing general anaesthesia.

Refer to the text below the tool for more information about this risk prediction score and its application.


The Apfel Score can help clinicians stratify patients at risk of PONV and who would benefit from prophylactic antiemetics.

Postoperative nausea and vomiting are not only uncomfortable for patients but may also prolong hospitalization and even lead to more serious complications such as aspiration pneumonia.


Apfel scores range from 0 to 4, where the higher the score, the greater the predicted 24-h risk of PONV. Recommendation is to consider anti-emetics in patients with higher scores.

Apfel Score 24-h risk of Postoperative Nausea and Vomiting
0 10%
1 21%
2 39%
3 61%
4 79%

1

Sex

2

Smoking status

3

History of motion sickness or PONV

4

Use of postoperative opioids

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About Apfel Score for PONV

Postoperative nausea and vomiting are not only uncomfortable for patients but may also prolong hospitalization and even lead to more serious complications such as aspiration pneumonia.

Tools such as the Apfel Score can help clinicians stratify patients at risk of PONV and who would benefit from prophylactic antiemetics.

The score includes four variables and assigns one point where applicable. Each of these risk factors is supposed to elevate the PONV-incidence about 20%

Apfel Score 0 points 1 point
Sex Male Female
Smoking status Smoker Non-smoker
History of motion sickness or PONV No Yes
Use of postoperative opioids No Yes

Apfel scores range from 0 to 4, where the higher the score, the greater the predicted 24-h risk of PONV. Recommendation is to consider anti-emetics in patients with higher scores.

Apfel Score 24-h risk of Postoperative Nausea and Vomiting
0 10%
1 21%
2 39%
3 61%
4 79%

In a study by Pierre et al. on 428 adult in-patients scheduled for throat, thyroid, breast or gynecological surgery under general inhalational anesthesia, the Apfel-score presented with favourable discriminating and calibration properties for predicting the risk of PONV.

 

References

Original reference

Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91(3):693-700.

Validation

Weilbach C, Rahe-meyer N, Raymondos K, Weissig A, Scheinichen D, Piepenbrock S. Postoperative nausea and vomiting (PONV): usefulness of the Apfel-score for identification of high risk patients for PONV. Acta Anaesthesiol Belg. 2006; 57(4):361-3.

Pierre S, Benais H, Pouymayou J. Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anaesth. 2002; 49(3):237-42.


Specialty: Surgery

Objective: Risk Stratification

Year Of Study: 1999

Article By: Denise Nedea

Published On: October 16, 2020

Last Checked: October 16, 2020

Next Review: October 16, 2025