Apfel Score for PONV

When it activates

Scribeable activates a calculator from the encounter. The Apfel Score for PONV can activate when the transcript or pasted chart context documents any of these:

• Pre-operative PONV risk assessment
• Antiemetic prophylaxis decision
• Post-operative nausea management
• Surgical anesthesia planning

Note-type scope: it activates on notes whose subject resolves to perioperative, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

4 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Female (+1), Non-smoker (+1), History of PONV/motion sickness (+1), Postoperative opioids (+1). Score 0-4.

Interpretation

0: 10% risk. 1: 21%. 2: 39%. 3: 61%. 4: 79%. Score ≥2: Consider prophylactic ondansetron, dexamethasone, or multimodal prophylaxis.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Apfel CC et al. 1999.

• Apfel CC et al. A simplified risk score for predicting postoperative nausea and vomitingApfel et al. (PONV) 1999 · 1999 · Level I · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Apfel Score for PONV (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. A stated Apfel Score for PONV value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.

Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.

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Can activate in: Surgery, Anesthesiology.