Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 144 No. 5152 (2014)

SwissScoring – a nationwide survey of SAPS II assessing practices and its accuracy

  • Marco Previsdomini
  • Bernard Cerutti
  • Paolo Merlani
  • Mark Kaufmann
  • Elisabeth van Gessel
  • Hans Ulrich Rothen
  • Andreas Perren
DOI
https://doi.org/10.4414/smw.2014.14090
Cite this as:
Swiss Med Wkly. 2014;144:w14090
Published
15.12.2014

Abstract

OBJECTIVE: The first description of the simplified acute physiology score (SAPS) II dates back to 1993, but little is known about its accuracy in daily practice. Our purpose was to evaluate the accuracy of scoring and the factors that affect it in a nationwide survey.

METHODS: Twenty clinical scenarios, covering a broad range of illness severities, were randomly assigned to a convenience sample of physicians or nurses in Swiss adult intensive care units (ICUs), who were asked to assess the SAPS II score for a single scenario. These data were compared to a reference that was defined by five experienced researchers. The results were cross-matched with demographic characteristics and data on the training and quality control for the scoring, structural and organisational properties of each participating ICU.

RESULTS: A total of 345 caregivers from 53 adult ICU providers completed the SAPS II evaluation of one clinical scenario. The mean SAPS II scoring was 42.6 ± 23.4, with a bias of +5.74 (95%CI 2.0–9.5) compared to the reference score. There was no evidence of bias variation according to the case severity, ICU size, linguistic area, profession (physician vs. nurse), experience, initial SAPS II training, or presence of a quality control system.

CONCLUSION:This nationwide survey revealed substantial variability in the SAPS II scoring results. On average, SAPS II scoring was overestimated by more than 13%, irrespective of the profession or experience of the scorer or of the structural characteristics of the ICUs.

References

  1. Moreno RP, Hochrieser H, Metnitz B, Bauer P, Metnitz PGH. Characterizing the risk profiles of intensive care units. Intensive Care Med. 2010;36(7):1207–12.
  2. Minne L, Eslami S, de Keizer N, de Jonge E, de Rooij SE, Abu-Hanna A. Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment. Intensive Care Med. 2011;38(1):40–6.
  3. Vosylius S, Sipylaite J, Ivaskevicius J. Evaluation of intensive care unit performance in Lithuania using the SAPS II system. Eur J Anaesthesiol. 2004;21(8):619–24.
  4. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.
  5. SAPS II Calculator [Internet]. 2014. Available from: http://clincalc.com/IcuMortality/SAPSII.aspx
  6. Metnitz PGH, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3 – From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med. 2005;31(10):1336–44.
  7. Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3 – From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31(10):1345–55.
  8. Deutsches Institut für Medizinische Dokumentation und Information, OPS Version 2014, Kapitel 8, Nichtoperative Therapeutische Massnahmen 8–98, 2014, Dokumentationsvorgaben zur Erfassung der Intensivmedizinischen Komplexbehandlung. Available from: http://www.dimdi.de/static/de/klassi/faq/ops/kapitel_8/ops-anleitung-intensivmedizin-8009.pdf
  9. Klassifikationen BM. Schweizerische Operationsklassifikation (CHOP). Statistik BF, editor. 2013 Jul 31. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/infothek/nomenklaturen/blank/blank/chop/02/05.html
  10. Rothen HU, Kaufmann M. Ein wichtiges Instrument zur Qualitäts-sicherung in der Intensivmedizin. The Medical Journal. 2009;2:18–21.
  11. Strand K, Strand LI, Flaatten H. The interrater reliability of SAPS II and SAPS 3. Intensive Care Med. 2010;36(5):850–3.
  12. Arts D, de Keizer N, Scheffer G-J, de Jonge E. Quality of data collected for severity of illness scores in the Dutch National Intensive Care Evaluation (NICE) registry. Intensive Care Med. 2002;28(5):656–9.
  13. Grønlykke L, Brandstrup SLR, Perner A. Data from clinical database on septic shock are valid. Dan Med J. 2012;59(10):A4522.
  14. Perren A, Previsdomini M, Perren I, Merlani P. Critical Care Nurses Inadequately Assess SAPS II Scores of Very Ill Patients in Real Life. Crit Care Res Pract. 2012;2012:919106.
  15. Strand K, Søreide E, Aardal S, Flaatten H. A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit population. Acta Anaesthesiol Scand. 2009;53(5):595–600.
  16. Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101–10.
  17. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33(2):363–74.
  18. Fleiss JL. Measuring nominal scale agreement among many raters. Psychological Bulletin. 1971;76(5):378–82.
  19. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.
  20. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychological Methods. American Psychological Association; 1996;1(1):30–46.
  21. Altman DG, Bland JM. Measurement in Medicine: the Analysis of Method Comparison Studies. The statistician. 1983;32:307–17.
  22. Anerkannte Intensivstationen. 2013 Oct 23. Available from: http://www.sgi-ssmi.ch/index.php/liste-der-anerkannten-is.html
  23. Miranda DR, Moreno R, Iapichino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med. 1997;23(7):760–5.
  24. Arts DGT, de Keizer NF, Vroom MB, de Jonge E. Reliability and accuracy of Sequential Organ Failure Assessment (SOFA) scoring. Crit Care Med. 2005;33(9):1988–93.
  25. Chen LM, Martin CM, Morrison TL, Sibbald WJ. Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med. 1999;27(9):1999–2004.
  26. Holt AW, Bury LK, Bersten AD, Skowronski GA, Vedig AE. Prospective evaluation of residents and nurses as severity score data collectors. Crit Care Med. 1992;20(12):1688–91.
  27. Goldhill DR, Sumner A. APACHE II, data accuracy and outcome prediction. Anaesthesia. 1998;53(10):937–43.
  28. Polderman KH, Christiaans HM, Wester JP, Spijkstra JJ, Girbes AR. Intra-observer variability in APACHE II scoring. Intensive Care Med. 2001;27(9):1550–2.
  29. Polderman KH, Jorna EM, Girbes AR. Inter-observer variability in APACHE II scoring: effect of strict guidelines and training. Intensive Care Med. 2001;27(8):1365–9.
  30. Bosman RJ, Oudemane van Straaten HM, Zandstra DF. The use of intensive care information systems alters outcome prediction. Intensive Care Med. 1998;24(9):953–8.
  31. Suistomaa M, Kari A, Ruokonen E, Takala J. Sampling rate causes bias in APACHE II and SAPS II scores. Intensive Care Med. 2000;26(12):1773–8.

Most read articles by the same author(s)