Evaluation of illness severity scoring systems and risk prediction in vascular intensive care admissions.
BACKGROUND
This study examines the predictive value of intensive care unit (ICU) scoring systems in a vascular ICU population.


METHODS
From April 2005 to September 2011, we examined 363 consecutive ICU admissions. Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE IV, Multiple Organ Dysfunction Score (MODS), organ dysfunctions and/or infection (ODIN), mortality prediction model (MPM) and physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM) were calculated. The Glasgow Aneurysm Score (GAS) was calculated for patients with aneurysm-related admissions.


RESULTS
Overall mortality for complex vascular intervention was 11.6%. At admission, the areas under the receiver operating characteristic curve (AUCs) was 0.884 for SAPS II, 0.894 for APACHE II, 0.895 for APACHE IV, 0.902 for MODS, 0.891 for ODIN and 0.903 for MPM. At 24 h, model discrimination was best for POSSUM (AUC = 0.906) and MPM (AUC = 0.912).


CONCLUSIONS
The good discrimination of these scoring systems indicates their value as an adjunct to clinical assessment but should not be used on an individual basis as a clinical decision-making tool.
Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland.
M
M
Dover
Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, National University of Ireland, Galway, Republic of Ireland.
Wael
W
Tawfick
Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Republic of Ireland.
Niamh
N
Hynes
Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, National University of Ireland, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Republic of Ireland sherif.sultan@hse.ie.
Sherif
S
Sultan
D018806:APACHE; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019540:Area Under Curve; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D006801:Humans; D007362:Intensive Care Units; D063305:Organ Dysfunction Scores; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D000072878:Simplified Acute Physiology Score
Illness severity score; clinical audit; complex major vascular intervention; intensive care