Editorial commentThe EuroSCORE risk stratification system in the current era: how accurate is it and what should be done if it is inaccurate?

Choong, Cliff Khuat Chye; Sergeant, Paul; Nashef, Samer A.M.; Smith, Julian Anderson; Bridgewater, Ben

doi:10.1016/j.ejcts.2008.10.009

Cited by 56 publications

(44 citation statements)

References 9 publications

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“…The SCTS has used both the logistic EuroSCORE and a modified EuroSCORE model for risk-adjustment purposes 7,8 ; however, both models are now poorly calibrated for contemporary cardiac surgery. 9 The EuroSCORE II is now being considered for future SCTS risk-adjustment purposes after a successful contemporary validation exercise.…”

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confidence: 99%

Performance of the EuroSCORE Models in Emergency Cardiac Surgery

Grant

Hickey

Dimarakis

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background— Accurate risk-adjustment models are useful for clinical decision making and are important for minimizing any tendency toward risk-averse clinical practice. In cardiac surgery, emergency patients are potentially at greatest risk of inappropriate risk-averse clinical decisions. UK cardiac surgery outcomes are currently risk-adjusted with EuroSCORE models. The objective of this study was to assess the performance of the EuroSCORE models in emergency cardiac surgery. Methods and Results— The National Institute for Cardiovascular Outcomes Research database was used to identify adult cardiac surgery procedures performed in the United Kingdom between April 2008 and March 2011. A subset of procedures (July 2010–March 2011) was used for EuroSCORE II validation. The outcome measure was in-hospital mortality. Model calibration (Hosmer–Lemeshow test, calibration plots, calculation of calibration intercept and slope) and discrimination (area under receiver-operating characteristic curve [area under the curve]) were assessed. In total, 109 988 cardiac procedures at 41 hospitals were included, of which 3342 were defined as emergency procedures. Compared with performance in all cardiac surgery and nonemergency cardiac surgery, the logistic EuroSCORE and EuroSCORE II models had poorer discrimination (area under the curve, 0.703 and 0.690, respectively) and poorer calibration for emergency surgery. The EuroSCORE risk factors of female sex, chronic pulmonary disease, neurological disease, active endocarditis, unstable angina, recent myocardial infarction, and pulmonary hypertension were not identified as important risk factors for emergency cardiac surgery. Conclusions— Both EuroSCORE models demonstrated poor calibration and comparatively poor discrimination for emergency cardiac surgery. This has important implications when these models are used for clinical decision making or to adjust governance analyses.

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confidence: 99%

Performance of the EuroSCORE Models in Emergency Cardiac Surgery

Grant

Hickey

Dimarakis

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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“…These methods include model recalibration (estimation of the intercept and slope of the model linear predictor term), complete model refitting, augmentation of models with additional covariates, and other complex regression techniques. [14][15][16][17] The Society for Cardiothoracic Surgery in Great Britain and Ireland have used a recalibrated and updated EuroSCORE model since 2007 for audit purposes, 9 estimated from contemporary clinical data. The New York State cardiac surgery program also uses the standard approach of periodic model recalibration.…”

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confidence: 99%

Dynamic Prediction Modeling Approaches for Cardiac Surgery

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Grant²,

Caiado³

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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“…It has been shown to be a better predictor than the additive EuroSCORE for high-risk patients, but continues to overestimate mortality by a factor of approximately 2.5 in the 6 risk classes in European, American and Australian studies [2,4]. These results have been associated to improvements in surgical techniques and perioperative care which results in a reduction of hospital mortality.…”

Section: Article P 495mentioning

confidence: 90%

“…Ninety-seven risk factors were studied and, of those, 17 were identified as being significantly associated with increased surgical mortality. The additive EuroSCORE overpredicts risk in coronary and valvular surgery, underpredicts observed mortality for combined valve and coronary surgery and has poor predictive ability for patients at higher risk [2].…”

Section: Article P 495mentioning

confidence: 99%