To explore translation, conversion and definition ambiguities, when using severity scoring systems in patients admitted to intensive care units (ICUs).
A prospective study of the prognosis of acute renal failure in ICUs.
The study was conducted in 20 French ICUs.
360 patients presenting with severe acute renal failure were studied during their ICU stay.
Measurements and results
The inter-observer variability of Apache II (acute physiology and chronic health evaluation), SAPS (simplified acute physiology score), and OSF (organ-system failure) was considered. For Apache II, we explored the uncertainty of measurements arising from conversion into SI units, the rounding procedures used for the non-inclusive intervals defined for quatitative parameters such as age, mean arterial pressure (MAP) or serum creatinite, the absence of definition of acute renal failure (ARF) and its consequence on doubling serum creatinine values, and the absence of guidelines in the case of spontaneous ventilation when arterial blood gases (ABG) and forced inspiratory oxygen (FIO2) were not measured. The resulting variability was evaluated, calculating the lowest and the highest value of the scoring system for each patient. The mean difference by patient was greater than 1.5 (p<0.0001). Other examples were presented and discussed for SAPS and OSF.
Translation, conversion and definition ambiguities are a source of inter-observer variability and increase the risk of classification and/or selection biases. This gives rise to particular concern in the design and analysis of multicenter trials or meta-analysis, and improvement of these scoring systems should be envisaged in the future.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Le Gall JR, Loirat P (1990) Evaluation en réanimation. (Collection d'anesthésiologie et de réanimation). Masson, Paris
Chang RWS, Jacobs S (1986) Use of Apache II severity of disease classification to identify intensive-care-unit patients who would not benefit from total parenteral nutrition. Lancet II: 1483–1487
Wagner DP, Knaus WA, Draper EA, Zimmerman JE (1983) Identification of low-risk monitor patients within a medical-surgical intensive care unit. Med Care 21:425–434
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 202:685–693
Chang RWS (1989) Individual outcome prediction models for intensive care units. Lancet II:143–146
Le Gall JR (1986) The intensive care unit: definitions and managerial differences. A French multicentric study on 38 units. Elsevier, Amsterdam, pp 39–54
Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M (1982) Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med 10:575–577
French multicenter group of ICU research; INSERM Unit 169 of statistical and epidemiological studies (1989) Factors related to outcome in intensive care: French multicenter study. Crit Care Med 17:305–308
Knaus WA, Wagner DP, Draper EA et al (1991) The Apache III prognostic system. Chest 100:1619–1636
The French Study Group on ARF, Agostini MM, Mezzarobba P, Kleinknecht D, Loirat P, Brivet F, Landais P (1992) Prognosis of acute renal failure in intensive care units. A prospective multicenter study. Intensive Care Med 18 [Suppl 2]:S65
French Multicenter Group, Mezzarobba P, Agostini MM, Loirat P, Kleinknecht D, Brivet F, Landais P (1992) Comparison of SAPS, Apache II and OSF in the evaluation of severe acute renal failure. Intensive Care Med 18 [Suppl 2]:S65
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Apache II: a severity of disease classification system. Crit Care Med 13:818–829
Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12: 975–977
Le Gall JR, Loirat P, Alperovitch A (1989) The simplified acute physiology score (SAPS). Probl Crit Care 3: 578–584
Rauss A, Knaus WA, Patois E, Le Gall JR, Loirat P (1990) Prognosis from multiple organ system failure: the reliability of objective estimates for survival. Med Decis Making 10:155–162
About this article
Cite this article
Féry-Lemonnier, E., Landais, P., Loirat, P. et al. Evaluation of severity scoring systems in ICUs—translation, conversion and definition ambiguities as a source of inter-observer variability in Apache II, SAPS and OSF. Intensive Care Med 21, 356–360 (1995). https://doi.org/10.1007/BF01705416
- Scoring systems
- Inter-observer variability
- Acute renal failure