title: External validation of modified EuroSCORE.
abstract: BACKGROUND
  EuroSCORE is an adult cardiac surgery risk scoring method that is used worldwide, which has been shown to significantly overestimate the operative risk. We derived a new risk scoring method by modifying some of the risk factors included in the EuroSCORE algorithm and we validated it in an external database.
  
  
  METHODS
  This study included 4,014 patients who underwent adult cardiac surgery at the Heart Centre, Tampere University Hospital, Finland. Operative risk was estimated by EuroSCORE and its modified version.
  
  
  RESULTS
  In-hospital postoperative mortality rate was 3.2%. EuroSCORE (AUC for logistic EuroSCORE 0.82; 95% confidence interval (CI), 0.79-0.85) and modified score (AUC for logistic modified score 0.79; 95% CI, 0.75-0.83) performed well in predicting in-hospital mortality in this series. The mean logistic EuroSCORE was 8%, and the mean logistic modified score was 2.2%. Thus, the observed to expected ratio for in-hospital mortality was 0.4 for logistic EuroSCORE and 1.5 for logistic modified score. The difference between observed and predicted mortality rate matched correctly for increasing additive modified score, but not for EuroSCORE. The observed to predicted ratio in high-risk patients (within the 90th percentile of each risk algorithm) was 0.36 (13.2%/36.2% in 402 patients) for logistic EuroSCORE and 0.99 (14.7%/14.9% in 395 patients) for logistic modified score.
  
  
  CONCLUSIONS
  This modified and simplified score, which includes most of EuroSCORE variables, seems to provide a more realistic estimation of postoperative mortality risk of patients undergoing any adult cardiac surgery.
authors.affiliation: Division of Cardio-Thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland, fausto.biancari@ppshp.fi.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Jari
authors.initials: J
authors.lastname: Laurikka
authors.forename: Jan-Ola
authors.initials: JO
authors.lastname: Wistbacka
authors.forename: Juha
authors.initials: J
authors.lastname: Nissinen
authors.forename: Matti
authors.initials: M
authors.lastname: Tarkka
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
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