Prospective comparison of three risk score models at three different surgical intensive care units.

PURPOSE: Although risk score models are of great value, their use is restricted because of the additional effort involved. The aim of this study was to compare three different score systems. Each of these requires a different degree of effort by the medical staff. One of the score systems is solely based on routine laboratory parameters. Data were collected on three different ICUs units, with each showing a large variety in patients' health conditions. METHODS: Prospective data of 588 surgical patients were collected by means of Acute Physiology and Chronic Health Evaluation II (APACHE II), Dense Laboratory Whole Blood Applied Risk Estimation (DELAWARE), and Simplified Acute Physiology Score II (SAPS II) score systems. These patients were admitted to three different intensive care units over a period of 12 months. On the day of admission, predicted hospital survival and mortality were evaluated. RESULTS: With a cutoff value of 0.6, the sensitivity of the APACHE II, DELAWARE, and SAPS II was at 0.19, 0.24, and 0.21; the specificity was at 0.98, 0.92, and 0.98; and the correct classification rate at 0.86, 0.83, and 0.86. The r(2) value was 0.35 for the APACHE II, 0.12 for the DELAWARE, and 0.21 for the SAPS II. The hospital mortality rate was overestimated in all three score systems. CONCLUSIONS: The results of this first multicenter study comparing three risk score systems indicate that it is possible to establish a general risk score for surgical intensive care patients on admission date. Such a risk score is solely based on quality-controlled, low-cost routine laboratory parameters.

Long-term comparison of a routine laboratory parameter-based severity score with APACHE II and SAPS II.

BACKGROUND: Risk score models predicting mortality have tremendous value, but because of the additional effort involved, their clinical use remains low. The aim of this study is to compare three different scores that each requires different levels of effort during admission and throughout treatment: the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiology Score II (SAPS II), and the Dense Laboratory Whole Blood Applied Risk Estimation (DELAWARE) score. Of the three, only the DELAWARE is based solely on routine laboratory parameters. METHODS: Prospective data of the three scores were collected for 268 surgical patients admitted to the intensive care unit over 1 year. The predicted hospital mortality and survival were evaluated for the first 14 days. RESULTS: With a cutoff value of 0.65, the sensitivity of the DELAWARE was 71.6%, the specificity, 92.5%, and the correct classification rate, 87.3%. The APACHE II and SAPS II showed values of 41.2%/96.8%/86.2% and 62.7%/87.1%/82.5%, respectively. The r2 value was 0.884 for the DELAWARE, 0.876/0.814 for the APACHE II and SAPS II. Hospital mortality rate was overestimated by 20% to 65% in all scores. The discriminatory ability of the APACHE II and SAPS II increased throughout the course of treatment. CONCLUSIONS: The routine laboratory-based DELAWARE provides a reliable, valid risk assessment of the surgical intensive care patient at admission. It also provides additional information without added effort or poor interobserver reliability, which leads to better data comparability. We have to state that until now the data have been collected in a single-center and their general validity is therefore limited. By the end of treatment, the SAPS II and APACHE II had increased discriminatory ability and are therefore useful as process parameters.