Abstract
Objective
To test the prognostic performance of the SAPS 3 Admission Score in a regional cohort and to empirically test the need and feasibility of regional customization.
Design
Prospective multicenter cohort study.
Patients and setting
Data on a total of 2,060 patients consecutively admitted to 22 intensive care units in Austria from October 2, 2006 to February 28, 2007.
Measurements and results
The database includes basic variables, SAPS 3, length-of-stay and outcome data. The original SAPS 3 Admission Score overestimated hospital mortality in Austrian intensive care patients through all strata of the severity-of-illness. This was true for both available equations, the General and the Central and Western Europe equation. For this reason a customized country-specific model was developed, using cross-validation techniques. This model showed excellent calibration and discrimination in the whole cohort (Hosmer–Lemeshow goodness-of-fit: Ĥ = 4.50, P = 0.922; Ĉ = 5.61, P = 0.847, aROC, 0.82) as well as in the various tested subgroups.
Conclusions
The SAPS 3 Admission Score’s general equation can be seen as a framework for addressing the problem of outcome prediction in the general population of adult ICU patients. For benchmarking purposes, region-specific or country-specific equations seem to be necessary in order to compare ICUs on a similar level.
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Acknowledgments
We thank the members of the ASDI study group and their respective study co-ordinators in each ICU: Günter Sagmüller, UKH Meidling, Vienna; Franz Schwameis, Landesklinikum Thermenregion Baden, Baden; Brigitte Pichler, Landesklinikum Weinviertel Mistelbach/Gänserndorf, Mistelbach; Felix Ernst, Landesklinikum Weinviertel Mistelbach/Gänserndorf, Mistelbach; Thomas Bauer, Landesklinikum Krems, Krems A. D. Donau; Franz Sterrer, A. ö. LKH Vöcklabruck, Vöcklabruck; Helmut Trimmel, A. ö. KH Wiener Neustadt, Wiener Neustadt; Walter Klimscha, Donauspital SMZ Ost, Vienna; Dieter Linemayr, Landesklinikum Mödling, Mödling; Johannes Schuh, A. ö. KH Wiener Neustadt, Wiener Neustadt; Gabriele Sprinzl, Landesklinikum Donauregion Tulln, Tulln; Kurt Dörre, A. ö. KH Waidhofen a.d. Thaya, Waidhofen A. D. Thaya; Helmut Trimmel, A. ö. KH Wiener Neustadt, Wiener Neustadt; Günther Frank, A. ö. KH der Barmherzigen Brüder Eisenstadt, Eisenstadt; Heinz Malle, UKH Klagenfurt, Klagenfurt; Ingrid Schindler, Sozialmedizinisches Zentrum Floridsdorf, Vienna; Sylvia Fitzal, Wilhelminenspital der Stadt Wien, Vienna; Reinhard Schuster, Donauspital SMZ Ost, Vienna; Gottfried Locker, AKH Wien Universitätskliniken, Vienna; Helmut Schneller, A. ö. KH der Barmherzigen Brüder Linz, Linz; Hubert Artmann, Kardinal Schwarzenberg’sches Krankenhaus, Schwarzach/Pongau; Oswald Schuberth, A. ö. LKH Steyr, Steyr; Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, Project # 12690 ONB.
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The authors declare that there exist no financial or other conflicts of interest. None of the authors has recently been employed or received reimbursements, fees, funding, or salary by/from an organization that may in any way gain or lose financially from the publication of this manuscript. No author holds any stocks or shares or patents in/from an organization that may in any way gain or lose financially from the publication of this manuscript.
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Metnitz, B., Schaden, E., Moreno, R. et al. Austrian validation and customization of the SAPS 3 Admission Score. Intensive Care Med 35, 616–622 (2009). https://doi.org/10.1007/s00134-008-1286-2
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DOI: https://doi.org/10.1007/s00134-008-1286-2