title: SwissScoring--a nationwide survey of SAPS II assessing practices and its accuracy.
abstract: OBJECTIVE
  The first description of the simplified acute physiology score (SAPS) II dates back to 1993, but little is known about its accuracy in daily practice. Our purpose was to evaluate the accuracy of scoring and the factors that affect it in a nationwide survey.
  
  
  METHODS
  Twenty clinical scenarios, covering a broad range of illness severities, were randomly assigned to a convenience sample of physicians or nurses in Swiss adult intensive care units (ICUs), who were asked to assess the SAPS II score for a single scenario. These data were compared to a reference that was defined by five experienced researchers. The results were cross-matched with demographic characteristics and data on the training and quality control for the scoring, structural and organisational properties of each participating ICU.
  
  
  RESULTS
  A total of 345 caregivers from 53 adult ICU providers completed the SAPS II evaluation of one clinical scenario. The mean SAPS II scoring was 42.6 ± 23.4, with a bias of +5.74 (95%CI 2.0-9.5) compared to the reference score. There was no evidence of bias variation according to the case severity, ICU size, linguistic area, profession (physician vs. nurse), experience, initial SAPS II training, or presence of a quality control system.
  
  
  CONCLUSIONS
  This nationwide survey revealed substantial variability in the SAPS II scoring results. On average, SAPS II scoring was overestimated by more than 13%, irrespective of the profession or experience of the scorer or of the structural characteristics of the ICUs.
authors.affiliation: Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Previsdomini
authors.affiliation: Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cerutti
authors.affiliation: Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, and Intensive Care Unit, University Hospital and University of Geneva, Geneva, Switzerland.
authors.forename: Paolo
authors.initials: P
authors.lastname: Merlani
authors.affiliation: Department of Anaesthesiology, University Hospital, Basel, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Kaufmann
authors.affiliation: Center for Interprofessional Education and Simulation, Faculty of Medicine, University of Geneva, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: van Gessel
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital, Inselspital, Bern, Switzerland.
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Rothen
authors.affiliation: Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Perren
mesh_terms: D000328:Adult; D015982:Bias; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D011785:Quality Assurance, Health Care / Q000379:methods; D011786:Quality Control; D012016:Reference Values; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013557:Switzerland