What question did this study set out to answer?

To compare the accuracy of hospital mortality prognoses made by intensive care physicians against the original and customized Simplified Acute Physiology Score (SAPS) II models.

August 1, 2004European Journal of Anaesthesiology

Outcome prediction in critical care: physicians’ prognoses vs. scoring systems

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Critical care (n=412). Intervention: Physicians' prognoses vs. SAPS II and customized SAPS II scoring systems. Primary outcome: Hospital mortality discrimination (AUC ROC) (95% CI 0.79-0.89).

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Key result

Physicians' prognoses for hospital mortality in critical care patients demonstrated superior discrimination compared to the SAPS II scoring system (AUC 0.84 vs 0.75).

Why the study?

Does prognostic judgement by intensive care physicians predict hospital mortality more accurately than objective scoring systems (SAPS II) in ICU patients?

Population

412 patients consecutively admitted to intensive care units of Göttingen University Hospital, Germany

Comparison

Prognostic judgement by intensive care physicians vs Original Simplified Acute Physiology Score II…

Design

Cohort

Follow-up

Until hospital discharge

Authors

NSN. ScholzUniversity of Minnesota KBK. BäslerUniversitätsmedizin Göttingen DSDorothee SaurUniversity Medical Center

Discussion

Member takes

Implication

Physician judgment may complement SAPS II for ICU mortality prediction; leaves open prospective validation before practice change.

Key Points

To compare the accuracy of hospital mortality prognoses made by intensive care physicians against the original and customized Simplified Acute Physiology Score (SAPS) II models.
Data were collected from 412 consecutive patients admitted to intensive care units at Göttingen University Hospital, Germany.
Physicians recorded their prognostic judgment regarding hospital mortality, and the cohort was split to develop a customized SAPS II model using logistic regression and bootstrapping.
Physicians' prognoses achieved an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.79–0.89).
The original SAPS II model yielded an area under the curve of 0.75 (95% CI: 0.69–0.80), while the customized SAPS model achieved 0.72 (95% CI: 0.66–0.78).
Physician forecasts demonstrated significantly higher prognostic accuracy than both scoring systems, with no substantial difference between the original and customized SAPS scores.

Study Design

Type

Observational (n=412)

Multicenter

Structured PICO

Does prognostic judgement by intensive care physicians predict hospital mortality more accurately than objective scoring systems (SAPS II) in ICU patients?

Population

412 patients consecutively admitted to intensive care units of Göttingen University Hospital, Germany

Intervention

Prognostic judgement by intensive care physicians

Comparator

Original Simplified Acute Physiology Score (SAPS) II and a customized SAPS II

Outcome

Hospital mortality (vital status on hospital discharge)hard clinical

Main Result

Absolute Event Rate: 0.84% vs 0.75%

Intensive care physicians' prognostic judgements are superior to objective scoring systems like SAPS II in predicting hospital mortality.

Limitations

Possible correlation between medical outcome and the clinician's prognosis because clinician actions depend on their initial prognosis.
Possible correlation between medical outcome and the clinician's prognosis due to treatment actions based on initial prognosis

Cite This Study

Scholz et al. (2004) conducted an observational in Critical care (n=412). Physicians' prognoses vs. SAPS II and customized SAPS II scoring systems was evaluated on Hospital mortality discrimination (AUC ROC) (95% CI 0.79-0.89). Physicians' prognoses for hospital mortality in critical care patients demonstrated superior discrimination compared to the SAPS II scoring system (AUC 0.84 vs 0.75).

synapsesocial.com/papers/6a1ab7cf382248a45185c4e7 https://doi.org/10.1017/s026502150400804x

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Outcome prediction in critical care: physicians’ prognoses vs. scoring systems

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Outcome prediction in critical care: physicians’ prognoses vs. scoring systems

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider