Schuster H P, Wilts S, Ritschel P
Medizinische Klinik I des Städtischen Krankenhauses Hildesheim.
Med Klin (Munich). 1996 Jun 15;91(6):343-8.
the main aim of the study was to assess the applicability of the Simplified Acute Physiology Score II (SAPS II) to the evaluation of outcome quality within the framework of quality assurance in patients in a medical intensive care unit. The outcome parameter employed was hospital mortality, measured as mortality index (hospital mortality actually observed/predicted mortality), the predicted mortality being derived from the individual mortality risk calculated for each patient in accordance with SAPS II.
For the period of one year, the SAPS II score, the individual mortality risk, the mean scores, mortality risk, intensive care and hospital mortality, and the mortality index (99% confidence interval) were calculated with the aid of a specially developed program for all 1,114 patients kept under observation or treated for longer than 4 hours in the intensive care unit. The entries (data) were monitored by random checks for the correctness of the individual entries and overall completeness of patient inclusion. The applicability of the SAPS II for our own patient material was checked with the aid of Receiver Operating Characteristic curves. In compliance with the original SAPS II to include patients of a coronary care unit but not to evaluate them, only the 604 patients with the diseases of medical intensive care were taken into account for quality control. High-risk groups (patients older than 76, critically ill patients with a mortality risk of more than 0,5, patients receiving respiratory support) and individual diagnostic categories were considered separately as subgroups.
In the entire group, the mean mortality risk was 21,1% the observed intensive care mortality 11,2%, the hospital mortality 18,0%, and the mortality index 0,86 (0,75 to 1,00). The mortality actually observed, therefore, corresponded to that predicted on the basis of the SAPS prognostic system. Also in the subgroups of elderly patients, and individual diagnostic categories (cerebral, bronchopulmonary cardiovascular, gastrointestinal diseases), the mortality index did not differ significantly from 1,0. A mortality index significantly less than 1,0 (observed mortality significantly lower than predicted mortality) was found in the sub-groups of the seriously ill, of patients receiving respiratory support, and in the diagnostic category of intoxications. The monthly analysis showed fluctuating mortality indices which, however, never differed significantly from 1,0. The surface under the ROC curve for the entire group was 0,89, and 0.81-0.99 for the various diagnostic categories.
The prognostic system SAPS II can be employed to evaluate the quality of outcome measured by hospital mortality in patients of a medical intensive care unit, provided that the applicability of the score is demonstrated for the patient material involved, the outcome of the overall group and of the high-risk groups is referred to the accuracy and completeness of the entered data is checked, and the scoring systems accepted as quality standard.
本研究的主要目的是评估简化急性生理学评分II（SAPS II）在医疗重症监护病房患者质量保证框架内对结局质量评估的适用性。所采用的结局参数为医院死亡率，以死亡率指数（实际观察到的医院死亡率/预测死亡率）衡量，预测死亡率根据按照SAPS II为每位患者计算的个体死亡风险得出。
在一年期间，借助专门开发的程序，为重症监护病房中所有1114名接受观察或治疗超过4小时的患者计算SAPS II评分、个体死亡风险、平均评分、死亡风险、重症监护和医院死亡率以及死亡率指数（99%置信区间）。通过随机检查监测录入（数据），以确保个体录入的正确性和患者纳入的总体完整性。借助受试者工作特征曲线检查SAPS II对我们自己患者资料的适用性。按照原始SAPS II纳入冠心病监护病房患者但不评估他们，仅将604名患有医疗重症监护疾病的患者纳入质量控制。将高危组（年龄大于76岁的患者、死亡风险超过0.5的重症患者、接受呼吸支持的患者）和个体诊断类别分别作为亚组进行考虑。
在整个组中，平均死亡风险为21.1%，观察到的重症监护死亡率为11.2%，医院死亡率为18.0%，死亡率指数为0.86（0.75至1.00）。因此，实际观察到的死亡率与基于SAPS预后系统预测的死亡率相符。在老年患者亚组以及个体诊断类别（脑、支气管肺、心血管、胃肠道疾病）中，死亡率指数与1.0无显著差异。在重症患者亚组、接受呼吸支持的患者亚组以及中毒诊断类别中，发现死亡率指数显著低于1.0（观察到的死亡率显著低于预测死亡率）。月度分析显示死亡率指数波动，但从未与1.0有显著差异。整个组的ROC曲线下面积为0.89，各个诊断类别的为0.81 - 0.99。
预后系统SAPS II可用于评估医疗重症监护病房患者以医院死亡率衡量的结局质量，前提是证明该评分对所涉及的患者资料具有适用性，将总体组和高危组的结局参考录入数据的准确性和完整性进行核对，并且将评分系统作为质量标准接受。
