Predicting outcome in the intensive care unit using scoring systems - Is new better? A comparison of SAPS and SAPS II in a cohort of 1,393 patients
Predicting outcome in the intensive care unit using scoring systems - Is new better? A comparison of SAPS and SAPS II in a cohort of 1,393 patients
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DOI：
10.1097/00005650-199809000-00009
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发表时间：
1998-09-01
期刊：
影响因子：
3
通讯作者：
Melotti, RM
中科院分区：
文献类型：
--
作者：
Bertolini, G;D'Amico, R;Melotti, RM
目标.本研究旨在比较新旧版本的简化急性生理学评分（SAPS和SAPS II）在根据住院死亡风险对患者进行分类方面的表现。为了比较两个系统的性能，采用了评分和观察到的死亡率之间的关联的测量，以及区分（受试者操作特征曲线下的面积）和校准（拟合优度统计）估计。受试者为1994年1个月内招募的1，393名合格患者。结果测量是出院时的生命状态。SAPS II与医院死亡率的相关性比早期版本更强。SAPS II：也比SAPS具有更好的区分能力（受试者操作特征曲线下面积0.80与0.74），并且预测的总死亡人数（416.5）比SAPS（267.7）更接近观察到的数字（475）。相反，SAPS和SAPS II都不符合我们的数据。拟合优度统计的P值均小于0.05。与SAPS相比，SAPS II在解释住院死亡率方面有真实的改善，但其标准参数与我们在意大利的数据不相符。在正式研究项目之外使用该评分系统之前，应澄清这种不匹配的潜在决定因素的作用和影响，例如与病例组合和/或护理质量相关的随机误差和混杂因素。当采用SAPS II预测死亡率以比较不同国家和护理系统的重症监护室性能时，建议特别谨慎。
OBJECTIVES. This study sought to compare the performance of the old and new versions of the Simplified Acute Physiology Score, SAPS and SAPS II, in classifying patients according to the risk of hospital mortality.METHODS. TO compare the performance of the two systems, measures of association between the scores and observed mortality were adopted, together with discrimination (area under the Receiver Operating Characteristics curve) and calibration (goodness-of-fit statistics) estimates. Subjects were 1,393 eligible patients recruited during 1 month in 1994. The outcome measure was vital status at hospital discharge.RESULTS. SAPS II was associated more strongly with hospital mortality than the earlier version. SAPS II: also had better discrimination ability than SAPS (area under Receiver Operating Characteristics curve 0.80 versus 0.74) and predicted an overall number of deaths (416.5) closer to the observed figure (475) than SAPS (267.7). Conversely, neither SAPS nor SAPS II fitted our data. Both P values derived from goodness-of-fit statistics were lower than 0.05.CONCLUSIONS. SAPS II offers a real improvement compared with SAPS in its ability to explain hospital mortality, but its standard parameters do not fit our data from Italy. The role and impact of potential determinants of this lack of fit, such as random errors and confounders related to casemix and/or quality of care should be clarified before this scoring system be used outside formal research projects. Special caution is suggested when SAPS II is adopted to predict mortality to compare intensive care unit performance across different countries and systems of care.