title: Prognostic performance of the Simplified Acute Physiology Score II in major Croatian hospitals: a prospective multicenter study.
abstract: OBJECTIVE
  To perform an external validation of the original Simplified Acute Physiology Score II (SAPS II) system and to assess its performance in a selected group of patients in major Croatian hospitals.
  
  
  METHODS
  A prospective, multicenter study was conducted in five university hospitals and one general hospital during a six-month period between November 1, 2007 and May 1, 2008. Standardized hospital mortality ratio (SMR) was calculated from the mean predicted mortality of all the 2756 patients and the actual mortality for the same group of patients. The validation of SAPS II was made using the area under receiver operating characteristic curve (AUC), 2×2 classification tables, and Hosmer-Lemeshow tests.
  
  
  RESULTS
  The predicted mortality was as low as 14.6% due to a small proportion of medical patients and the SMR being 0.89 (95% confidence interval [CI], 0.78-0.98). The SAPS II system demonstrated a good discriminatory power as measured by the AUC (0.85; standard error [SE]=0.012; 95% CI=0.840-0.866; P<0.001). This system significantly overestimated the actual mortality (Hosmer-Lemeshow goodness-of-fit H statistic: χ(2) =584.4; P<0.001 and C statistics: χ(2)(8) =313.0; P<0.001) in the group of patients included in the study.
  
  
  CONCLUSIONS
  The SAPS II had a good discrimination, but it significantly overestimated the observed mortality in comparison with the predicted mortality in this group of patients in Croatia. Therefore, caution is required when an evaluation is performed at the individual level.
authors.affiliation: Department for anesthesiology and ICM, University hospital Rijeka, Tome Strizica 3, Rijeka, Croatia. kristi@medri.hr
authors.forename: Kristian
authors.initials: K
authors.lastname: Desa
authors.forename: Mladen
authors.initials: M
authors.lastname: Peric
authors.forename: Ino
authors.initials: I
authors.lastname: Husedzinovic
authors.forename: Alan
authors.initials: A
authors.lastname: Sustic
authors.forename: Andelko
authors.initials: A
authors.lastname: Korusic
authors.forename: Vjekoslav
authors.initials: V
authors.lastname: Karadza
authors.forename: Drazen
authors.initials: D
authors.lastname: Matlekovic
authors.forename: Branka
authors.initials: B
authors.lastname: Prstec-Veronek
authors.forename: Marta
authors.initials: M
authors.lastname: Zuvic-Butorac
authors.forename: Jadranko
authors.initials: J
authors.lastname: Sokolic
authors.forename: Mladen
authors.initials: M
authors.lastname: Siranovic
authors.forename: Danica
authors.initials: D
authors.lastname: Bosnjak
authors.forename: Jasna
authors.initials: J
authors.lastname: Spicek-Macan
authors.forename: Denis
authors.initials: D
authors.lastname: Gustin
authors.forename: Drazenka
authors.initials: D
authors.lastname: Ozeg-Jakopovic
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D017523:Croatia; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020379:Risk Adjustment / Q000379:methods; D012720:Severity of Illness Index