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Apfel PONV score

Postoperative nausea and vomiting risk from four factors, with an educational multimodal prophylaxis ladder. The anesthesia clinician directs prophylaxis.

Risk factors present

Result

Score

0

of 4 factors

Approximate 24-hour risk

10%

Baseline risk

Routine pharmacologic prophylaxis is not generally required. Reassess if other risk factors are present and minimize avoidable triggers.

Educational reference. Prophylaxis choices are clinician directed.

Formula

  • Score = count of risk factors present (0 to 4)
  • Approximate 24-hour PONV risk: 0 -> 10%, 1 -> 21%, 2 -> 39%, 3 -> 61%, 4 -> 79%

Source

  • Apfel simplified risk score; prophylaxis ladder per the Fourth Consensus Guidelines for the management of postoperative nausea and vomiting (Gan et al., Anesth Analg 2020).

Clinical reference only. Verify independently; clinical judgment governs.