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a- e . Yorta rty an. pgar llstnoutlcns y ‘rlmary entice Deaths (%) Apgar Score (%) 5 6 .3: Primary Service Burn 1,558 Cardiac 3,513 Emergency 2,384

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Problem #1 (______/20)

At 1 minute after birth and again at 5 minutes, each newborn child is given a numerical rating called an Apgar Score. Possible values of this score are 0, 1, 2, …, 9, 10. A child’s score is determined by five factors: muscle tone, skin color, respiratory effort, strength of heartbeat, and reflex, with a high score  indicating a healthy infant.

The success of this Apgar Score in predicting post-birth problems has led to the use of an Apgar-like score in other medical situations. A recent paper (Anesthesiology, June 2011; see link at the end of this problem) discusses the success the Surgical Apgar Score in many medical subspecialties. In a method similar to the newborn scoring system, the Surgical Apgar Score uses three factors (estimated blood loss (EBL), lowest intraoperative heart rate (HR), and lowest intraoperative mean arterial pressure (MAP)) to assign a score of 0, 1, 2, …, 9, 10, to patients undergoing surgery in the postoperative setting. According to the article, “Strengths of the Surgical Apgar Score include the ability to calculate the score quickly and objectively. The provider could then anticipate the need for further or more aggressive interventions.”

The following table, taken directly from the article, shows the percent of patients receiving one of the Surgical Apgar Scores 0, 1, 2, …, 9, 10 for 21 different primary services. For example, 3.8% (0.038) of all Burn patients received an Apgar score of 3.

For Problem #1, we will focus on the use of the Surgical Apgar Score for Liver transplant. Let the variable  denote the score of a randomly selected Liver transplant patient at a particular hospital. Using Table 4, fill out the probability distribution for the random variable . I put in the first two probabilities for you!

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