SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description.
OBJECTIVE
Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment.


METHODS
Prospective multicentre, multinational cohort study.


METHODS
A total of 19,577 patients consecutively admitted to 307 ICUs from 14 October to 15 December 2002.


RESULTS
Data were collected at ICU admission, on days 1, 2 and 3, and the last day of the ICU stay. Data included sociodemographics, chronic conditions, diagnostic information, physiological derangement at ICU admission, number and severity of organ dysfunctions, length of ICU and hospital stay, and vital status at ICU and hospital discharge. Data reliability was tested with use of kappa statistics and intraclass-correlation coefficients, which were >0.85 for the majority of variables. Completeness of the data was also satisfactory, with 1 [0-3] SAPS II parameter missing per patient. Prognostic performance of the SAPS II was poor, with significant differences between observed and expected mortality rates for the overall cohort and four (of seven) defined regions, and poor calibration for most tested subgroups.


CONCLUSIONS
The SAPS 3 study was able to provide a high-quality multinational database, reflecting heterogeneity of current ICU case-mix and typology. The poor performance of SAPS II in this cohort underscores the need for development of a new risk adjustment system for critically ill patients.
Metnitz
Philipp G H
PG
Dept. of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria. philipp@metnitz.biz
Moreno
Rui P
RP
Almeida
Eduardo
E
Jordan
Barbara
B
Bauer
Peter
P
Campos
Ricardo Abizanda
RA
Iapichino
Gaetano
G
Edbrooke
David
D
Capuzzo
Maurizia
M
Le Gall
Jean-Roger
JR
D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index