PUBLIC LIBRARY / SCORE

Apfel score (postoperative nausea and vomiting)

Estimates adult nausea/vomiting risk in the first 24 hours after general anesthesia from four factors and guides antiemetic prophylaxis.

Calculate with transparency

Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Simplified Apfel 1999: 4 factors, 0–4; not the Koivuranta model

The simplified Apfel from 1999 was studied in adults under inhalational anesthesia, without antiemetic prophylaxis, for nausea or vomiting in the first 24 hours. Probabilities from the original cohort are not automatically recalibrated for children, other anesthetic techniques or people already receiving prophylaxis. Antiemetic strategy depends on its own assessment and guideline.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Female sex
Nonsmoker
History of postoperative nausea and vomiting or motion sickness
Planned postoperative opioid use

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

1 point per factor: female sex, nonsmoker, PONV or motion-sickness history, postoperative opioid.

References

Identifier: apfel

Original clinical content: Brazilian Portuguese.

Method version

Simplified Apfel 1999: 4 factors, 0–4; not the Koivuranta model

apfel@native-2026-10-03+f2feb09213a0

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Female sex: No
Nonsmoker: No
History of postoperative nausea and vomiting or motion sickness: No
Planned postoperative opioid use: No

{
  "fem": false,
  "naofuma": false,
  "historia": false,
  "opioide": false
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 2

reference-002

Inputs

Female sex: Yes
Nonsmoker: Yes
History of postoperative nausea and vomiting or motion sickness: No
Planned postoperative opioid use: No

{
  "fem": true,
  "naofuma": true,
  "historia": false,
  "opioide": false
}

Expected result

{
  "score": 2,
  "level": "mid",
  "verdict": "39%"
}

Actual result

{
  "score": 2
}

Case 3

reference-003

Inputs

Female sex: Yes
Nonsmoker: Yes
History of postoperative nausea and vomiting or motion sickness: Yes
Planned postoperative opioid use: Yes

{
  "fem": true,
  "naofuma": true,
  "historia": true,
  "opioide": true
}

Expected result

{
  "score": 4,
  "level": "high",
  "verdict": "79%"
}

Actual result

{
  "score": 4
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.