• Intensive care medicine · Nov 2009

    External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units.

    • Daniele Poole, Carlotta Rossi, Abramo Anghileri, Michele Giardino, Nicola Latronico, Danilo Radrizzani, Martin Langer, and Guido Bertolini.
    • Servizio Anestesia e Rianimazione, Ospedale Civile San Martino, Belluno, Italy. danest@libero.it
    • Intensive Care Med. 2009 Nov 1;35(11):1916-24.

    ObjectiveTo evaluate the SAPS 3 score predictive ability of hospital mortality in a large external validation cohort.DesignProspective observational study.Setting And PatientsA total of 28,357 patients from 147 Italian ICUs joining the Project Margherita national database of the Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva (GiViTI).InterventionsNone.MeasurementEvaluation of discrimination through ROC analysis and of overall goodness-of-fit through the Cox calibration test.Main ResultsAlthough discrimination was good, calibration turned out to be poor. The general and the South-Europe Mediterranean countries equations overestimated hospital mortality overall (SMR values 0.73 with 95% CI 0.72-0.75 for both equations) and homogeneously across risk classes. Overprediction was confirmed among important subgroups, with SMR values ranging between 0.47 and 0.82.ConclusionsThe result strictly supported by our data is that the SAPS 3 score calibrates inadequately in a large sample of Italian ICU patients and thus should not be used for benchmarking, at least in Italian settings.

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