title: Usefulness of simplified acute physiology score II in predicting mortality in patients admitted to an emergency medicine ward.
abstract: The Objective of this prospective observational study was to evaluate the applicability of the simplified acute physiology score (SAPS II) in patients admitted to an Emergency Medicine Ward in the Emergency Medicine Ward of a tertiary university hospital. We studied consecutive patients admitted to an Emergency Medicine Ward from the emergency department. The SAPS II was assessed in predicting overall in-hospital mortality in terms of sensitivity, specificity and receiver operating characteristic (ROC) curve. A total of 211 consecutive patients were admitted over a period of 2 months. Median SAPS II score was 28 (range 6-93), with a mean risk of in-hospital mortality of 0.17 (range 0.01-0.97) for the whole population, and an observed mortality of 15%. The area under the receiver operator curve (ROC) was 0.84 (0.77-0.91). Considering a cut-off value of SAPS II of 49, the sensitivity was 0.50 (95% CI 0.42-0.56), the specificity was 0.95 (0.92-0.98), the positive predictive value (PPV) was 0.64 (0.58-0.71), and the negative predictive value (NPV) was 0.91 (0.87-0.95), the positive likelihood ratio (pLH) was 9.9, and the negative likelihood ratio (nLH) was 0.5. If contrarily a cut-off value of SAPS II of 22 were used, the sensitivity would be 1.0, the specificity would be 0.21 (0.16-0.26), the PPV would be 0.18 (0.13-0.23), the NPV would be 1.0, the pLH would be 1.3, and the nLH would be 0.0. In this preliminary study, SAPS II predicted in-hospital mortality in patients admitted to an Emergency Ward.
authors.affiliation: Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, U.O. Medicina d'Urgenza, Gruppo NIV Policlinico, Via F. Sforza, 35, 20122 Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cosentini
authors.forename: Christian
authors.initials: C
authors.lastname: Folli
authors.forename: Massimo
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.forename: Federico
authors.initials: F
authors.lastname: Piffer
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Grazioli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milani
authors.forename: Marilena
authors.initials: M
authors.lastname: Pappalettera
authors.forename: Margherita
authors.initials: M
authors.lastname: Arioli
authors.forename: Francesca
authors.initials: F
authors.lastname: Tardini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Brambilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019370:Observation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D014218:Triage; D055815:Young Adult