title: External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units.
abstract: OBJECTIVE
  To evaluate the SAPS 3 score predictive ability of hospital mortality in a large external validation cohort.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A total of 28,357 patients from 147 Italian ICUs joining the Project Margherita national database of the Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva (GiViTI).
  
  
  METHODS
  None.
  
  
  METHODS
  Evaluation of discrimination through ROC analysis and of overall goodness-of-fit through the Cox calibration test.
  
  
  RESULTS
  Although discrimination was good, calibration turned out to be poor. The general and the South-Europe Mediterranean countries equations overestimated hospital mortality overall (SMR values 0.73 with 95% CI 0.72-0.75 for both equations) and homogeneously across risk classes. Overprediction was confirmed among important subgroups, with SMR values ranging between 0.47 and 0.82.
  
  
  CONCLUSIONS
  The result strictly supported by our data is that the SAPS 3 score calibrates inadequately in a large sample of Italian ICU patients and thus should not be used for benchmarking, at least in Italian settings.
authors.affiliation: Servizio Anestesia e Rianimazione, Ospedale Civile San Martino, Belluno, Italy. danest@libero.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Poole
authors.forename: Carlotta
authors.initials: C
authors.lastname: Rossi
authors.forename: Abramo
authors.initials: A
authors.lastname: Anghileri
authors.forename: Michele
authors.initials: M
authors.lastname: Giardino
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.forename: Danilo
authors.initials: D
authors.lastname: Radrizzani
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.forename: Guido
authors.initials: G
authors.lastname: Bertolini
mesh_terms: D018806:APACHE; D000368:Aged; D015982:Bias; D002138:Calibration; D016009:Chi-Square Distribution; D003422:Critical Care / Q000458:organization & administration; D016638:Critical Illness / Q000145:classification / Q000401:mortality; D003625:Data Collection / Q000379:methods / Q000592:standards; D003953:Diagnosis-Related Groups; D016002:Discriminant Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors
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