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

Perren, Andréas; Cerutti, Bernard; Merlani, Paolo; Perren, Ilaria; Previsdomini, Marco; Massarotto, Paola; Kaufmann, Mark; Rothen, Hans Ulrich

doi:10.4414/smw.2014.14090

Cited by 2 publications

(1 citation statement)

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“…Parameters eligible for risk stratification in critically ill patients are of utmost interest to optimize patients`outcome. Elaborated scoring tools such as APACHE and SAPS scores are available and well validated–still, their complexity and reliance on volatile parameters such as heart rate limits their use especially in initial patients`risk stratification [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

et al. 2018

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PurposeBlood urea nitrogen (BUN) was reported to be associated with mortality in heart failure patients. We aimed to evaluate admission BUN concentration in a heterogeneous critically ill patient collective admitted to an intensive care unit (ICU) for prognostic relevance.MethodsA total of 4176 medical patients (67±13 years) admitted to a German ICU between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. Association of admission BUN and both intra-hospital and long-term mortality were investigated by Cox regression. An optimal cut-off was calculated by means of the Youden-Index.ResultsPatients with higher admission BUN concentration were older, clinically sicker and had more pronounced laboratory signs of multi-organ failure including kidney failure. Admission BUN was associated with adverse long-term mortality (HR 1.013; 95%CI 1.012–1.014; p<0.001). An optimal cut-off was calculated at 28 mg/dL which was associated with adverse outcome even after correction for APACHE2 (HR 1.89; 95%CI 1.59–2.26; p<0.001), SAPS2 (HR 1.85; 95%CI 1.55–2.21; p<0.001) and several parameters including creatinine in an integrative model (HR 3.34; 95%CI 2.89–3.86; p<0.001). We matched 614 patients with admission BUN >28 mg/dL to case-controls ≤ 28mg/dL corrected for APACHE2 scores: BUN above 28 mg/dL remained associated with adverse outcome in a paired analysis with the difference being 5.85% (95%CI 1.23–10.47%; p = 0.02).ConclusionsHigh BUN concentration at admission was robustly associated with adverse outcome in critically ill patients admitted to an ICU, even after correction for co-founders including renal failure. BUN might constitute an independent, easily available and important parameter for risk stratification in the critically ill.

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Section: Introductionmentioning

confidence: 99%

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

et al. 2018

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Retrospective Assessment of the Standardized Mortality Ratio as a Measure of the Quality of Care in a Major Intensive Care Unit in the Republic of Cyprus

Iordanou¹,

Middleton

Papathanassoglou

et al. 2019

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IntroductionThe standardized mortality ratio (SMR) is commonly used to assess the overall quality of care by comparing the observed hospital mortality with the mortality predicted by statistical models. If the observed deaths are less than the predicted, the overall quality of care can be considered high; in the opposite case, it is low.AimThe aim of the study was to assess the overall quality of care in an intensive care unit (ICU) during the period of 2012 to 2017. We also reported our experience and lessons learned throughout the surveillance period.MethodsA retrospective study design was adopted. Healthcare-associated infections (HAI–ICU) protocol v1.1 was used in a major ICU for a period of 6 years. All patients admitted to the ICU during the surveillance period were included in the study. The SMR was measured.ResultsDuring the 6-year period, 1067 patients were admitted and remained hospitalized for more than 48 hours; 207 patients' discharge status was reported as “death”, compared to 309 deaths predicted based on the SAPS II score. The overall mean observed mortality rate during the study period was 19.4%, as opposed to 28.95% for the predicted mortality. The overall mean SMR was 0.62 (IQR 0.49-0.82). Difficulties were faced due to the lack of surveillance software, but they were overcome by the use of a freely available web-based form.ConclusionsThe overall quality of ICU care is considered to correspond to high-quality standards, since standardized mortality rates during the study period were lower than one. The use of the web-based form as an alternative solution to the surveillance software performed well in terms of recording data.

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

Abstract: 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.

Cited by 2 publications

References 23 publications

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

Retrospective Assessment of the Standardized Mortality Ratio as a Measure of the Quality of Care in a Major Intensive Care Unit in the Republic of Cyprus

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