Calculators · Anaesthesiology · Score
Apfel simplified PONV risk score
Also called Apfel score, PONV risk, postoperative nausea and vomiting score
Four-factor risk of postoperative nausea or vomiting within 24 h in adults having inhalational anaesthesia.
Apfel score
0 / 4
- Predicted PONV (24 h)
- 10%
0 risk factors: about 10% incidence of PONV in the derivation cohorts (Finnish and German adults, inhalational anaesthesia, no prophylaxis).
Formula and scoring
1 point each: female, PONV/motion-sickness history, non-smoker, postoperative opioids. 0/1/2/3/4 points → 10/21/39/61/79% PONV.
Exam and ward pearls
- Each added factor raises risk by roughly 20 percentage points – an easy viva line.
When not to rely on it
- Derived in adults under inhalational anaesthesia without antiemetic prophylaxis; not for children.
Source
- 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. doi:10.1097/00000542-199909000-00022 · PMID 10485781
Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.