Prognostic utilization of models based on the APACHE II,APACHE IV,and SAPS II scores for predicting in-hospital mortality in emergency department

BackgroundThis study was designed to evaluate and compare the prognostic value of the APACHE II, APACHE IV, and SAPSII scores for predicting in-hospital mortality in the ED on a large sample of patients. Earlier studies in the ED setting have either used a small sample or focused on specific diagnoses.MethodsA prospective study was conducted to include patients with higher risk of mortality from March 2016 to March 2017 in the ED of Emam Reza Hospital, northeast of Iran. Logistic regression was used to develop three models. Evaluation was performed in terms of the overall performance (Brier Score, BS, and Brier Skill Score, BSS), discrimination (Area Under the Curve, AUC), and calibration (calibration graph).ResultsA total of 2205 patients met the study criteria (53% male and median age of 64, IQR: 50–77). In-hospital mortality amounted to 19%. For APACHE II, APACHE IV, and SAPS II the BS was 0.132, 0.125 and 0.133 and the BSS was 0.156, 0.2, and 0.144, respectively. The AUC was 0.755 (0.74 to 0.779) for APACHE II, 0.794 (0.775 to 0.818) for APACHE IV, and 0.751 (0.727 to 0.776) for SAPS II. The APACHE IV showed significantly greater AUC in comparison to the APACHE II and SAPS II. The graphical evaluation revealed good calibration of the APACHE IV model.ConclusionAPACHEIV outperformed APACHEII and SAPSII in terms of discrimination and calibration. More validation is needed for using these models for decision-making about individual patients, although they would perform best at a cohort level.     

Sampling rate causes bias in APACHE II and SAPS II scores

OBJECTIVE: To study the effect of sampling rate of laboratory and haemodynamic data on severity scorings and predicted risk of hospital death. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit (ICU) with 23 beds in a university hospital. PATIENTS: Sixty-nine consecutive emergency admission patients. INTERVENTIONS: Blood samples were drawn from indwelling arterial lines for the laboratory tests of all variables contained in the APACHE II and SAPS II scores at 2-hourly intervals from the time of admission up to 24 h or earlier discharge or death of the patient. Haemodynamic data and temperature were collected either manually by the attending nurse once an hour or as 2-min median values automatically using a Clinical Information Management System (CIMS, Clinisoft, Datex-Ohmeda, Helsinki, Finland). Three sets of severity scores were obtained. (1) "Traditional" scores (haemodynamic data from manual records and laboratory values from tests taken at admission and subsequently on clinical basis only). (2) "CIMS" scores (haemodynamic data from 2-min median values and laboratory values prescribed on clinical indication) and (3) "High rate" scores (haemodynamic data from 2-min median values and laboratory values at 2-hourly intervals). Probability of hospital death was calculated using the SAPS II and APACHE II scores, respectively. RESULTS: Increasing the sampling rate of haemodynamic monitoring interval to 2-min from once per hour resulted in 7.8 % and 11.5 % increases (p < 0.001) in the APACHE II and SAPS II scores, respectively. The combined effect of increased sampling rate of haemodynamic and laboratory tests on the APACHE II and SAPS II scores was 14.4 % and 14.5 % compared to traditional scores (p < 0.001), respectively. The probability of hospital death increased from 0.23 and 0.21 ("traditional" SAPS II and APACHE II) to 0.31 and 0.25 ("high rate" SAPS II and APACHE II), respectively, and, because eight patients died, standardised mortality ratio (SMR) decreased from 0.53 to 0.41 (SAPS II) and from 0.60 to 0.50 (APACHE II). CONCLUSIONS: Increased sampling rate results in higher scores and lower SMR. Comparisons between hospitals using severity scores are biased due to differences in the sampling rates.     

Comparison of two simplified severity scores (SAPS and APACHE II) for patients with acute myocardial infarction

The Simplified Acute Physiology Score (SAPS), the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Acute Physiology Score (APS), and the Coronary Prognostic Index (CPI), calculated within the first 24 h of ICU admission, were compared in 76 patients with acute myocardial infarction (AMI). Sixteen (21%) patients subsequently died in the ICU. The nonsurvivors had significantly higher SAPS, APACHE II, and CPI scores than the survivors. ROC curves drawn for each severity index were in a discriminating position. There were no significant differences either between the areas under the ROC curves drawn for SAPS, APACHE II, and CPI, or between the overall accuracies of these indices. APS provided less homogeneous information. We conclude that SAPS and APACHE II, two severity indices which are easy to use, assess accurately the short-term prognosis, i.e., the ICU outcome, of patients with AMI.     

Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II

BACKGROUND: In recent years several scoring systems have been developed to describe the severity of illness, to establish the individual prognosis, and to group adult ICU patients by predicted risk of mortality. In addition, these scores can be used to measure and/or compare the quality of care in different ICUs. We compared the mortality predictions of the Acute Physiology and Chronic Health Evaluation (APACHE II) score and a new Simplified Acute Physiology Score (SAPS II) in patients with respiratory disease who require intensive care. PATIENTS & METHODS: We prospectively studied all 306 admissions from January 1, 1992 through December 31, 1994. McNemar and Hosmer-Lemeshow tests, and receiver operating characteristic (ROC) curves were used to describe and analyze our data. RESULTS: The average APACHE II score was 17.5 (SD 6.0), corresponding to a mean predicted death rate of 24.9% (SD 17.2%) as compared to an observed overall RICU mortality rate of 21.6%. The average SAPS II score was 39.1 (SD 11.1) corresponding to a mean predicted death rate of 26.0% (SD 18.4%). The ratio between the actual and predicted hospital mortality was 86% for APACHE II and 83% for SAPS II. Survivors had a significantly lower predicted risk of death than nonsurvivors (p < 0.0001) with both indices, and a higher Glasgow coma scale score (p < 0.0001). The ROC-curve analysis suggested the superior predictive ability of APACHE II in our patients. Area under the APACHE II ROC curve was 80.88% (standard error [SE] 2.89%), significantly larger (p < 0.01) than that found for SAPS II (73.52%, SE 3.61%). CONCLUSIONS: The APACHE II score was a good predictor of hospital outcome and better than SAPS II in our population.     

APACHEⅡ评分对全身炎症反应综合征患者预后的评估作用

目的探讨APACHEⅡ评分对全身炎症反应综合征(SIRS)的预后评估作用。方法回顾性分析总结2007年12月至2009年3月南京军区总医院呼吸科及腹部外科ICU中的92例SIRS的临床资料,并予以APACHEⅡ评分,根据病情转归分为存活组及死亡组,比较两组APACHEⅡ差异有无统计学意义。根据APACHEⅡ评分分为三组:A组(APACHEⅡ评分<15)、B组(15≤A-PACHEⅡ评分<25)和C组(APACHEⅡ评分≥25),分析三组之间的死亡率差异有无统计学意义。将92例SIRS患者依据感染发生与否再分为两组:SIRS感染组和SIRS非感染组,比较两组APACHEⅡ差异有无统计学意义。结果全身性感染组中死亡组的APACHEⅡ评分与存活组的评分差异有统计学意义(P<0.01);不同评分组的死亡率差异有统计学意义(P<0.01);SIRS感染组和SIRS非感染组的APACHEⅡ评分差异无统计学意义(P>0.05)。结论 APACHEⅡ评分对全身性感染预后有预示作用。     

External validation of the SAPS II,APACHE II and APACHE III prognostic models in South England: a multicentre study

OBJECTIVE: External validation of three prognostic models in adult intensive care patients in South England. DESIGN. Prospective cohort study. SETTING: Seventeen intensive care units (ICU) in the South West Thames Region in South England. PATIENTS AND PARTICIPANTS: Data of 16646 patients were analysed. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We compared directly the predictive accuracy of three prognostic models (SAPS II, APACHE II and III), using formal tests of calibration and discrimination. The external validation showed a similar pattern for all three models tested: good discrimination, but imperfect calibration. The areas under the receiver operating characteristics (ROC) curves, used to test discrimination, were 0.835 and 0.867 for APACHE II and III, and 0.852 for the SAPS II model. Model calibration was assessed by Lemeshow-Hosmer C-statistics and was Chi(2 )=232.1 for APACHE II, Chi(2 )=443.3 for APACHE III and Chi(2 )=287.5 for SAPS II. CONCLUSIONS: Disparity in case mix, a higher prevalence of outcome events and important unmeasured patient mix factors are possible sources for the decay of the models' predictive accuracy in our population. The lack of generalisability of standard prognostic models requires their validation and re-calibration before they can be applied with confidence to new populations. Customisation of existing models may become an important strategy to obtain authentic information on disease severity, which is a prerequisite for reliably measuring and comparing the quality and cost of intensive care.     

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

OBJECTIVE: To identify the risk for prolonged mechanical ventilation in cardiac surgical patients. DESIGN: Prospective study with retrospective combination of a second database. PATIENTS: Six hundred and eighty-seven patients after cardiac surgery over a period of 12 months. MEASUREMENTS: Demographic data were recorded preoperatively, and surgical procedures intraoperatively using a surgical database designed for quality control. Length of ICU and hospital stay, and hospital outcome were recorded. Severity of illness was assessed daily using APACHE II, SAPS II, and Organ Failure Score. Intensity of treatment and nursing care was monitored by means of the Therapeutic Intervention Scoring System (TISS). Univariate and multivariate analyses were performed using logistic regression. The predictive value of the identified variables was tested by the Wilcoxon test using the receiver operating characteristic curve. MAIN RESULTS: Sixty-two patients (9.0%) were ventilated for > 48 h and accounted for 42.8% of the total costs in the ICU. The pre- and intraoperatively collected data produced a model with weak predictive capacity for prolonged ventilation [area under curve (AUC) 73.22 and 71.08, respectively]. The use of TISS and SAPS postoperatively resulted in an effective model of prediction (AUC 93.76). Adding the occurrence of reoperation, reintubation, emergency transfusion, intraaortic balloon pumping, and need for total parenteral nutrition to the model further improved its predictive capacity (AUC 94.74). CONCLUSIONS: The present results strongly suggest that data collected postoperatively using established scoring systems as well as documented events of high clinical impact for risk assessment and quality control are reliable predictors of prolonged ventilation.     

Outcome prediction for patients with cirrhosis of the liver in a medical ICU: A comparison of the APACHE scores and liver-specific scoringsystems

Objective To find the most adequate prognostic scoring system for predicting ICU-outcome in patients with decompensated liver cirrhosis in a medical intensive care unit (ICU).Design Retrospective analysis of patients' records over a 10-year period.Setting A medical ICU at the university medical center of Vienna.Patients and participants: 94% (n=198) of all patients with cirrhosis admitted to our medical ICU throughout the 10-year study period.Interventions None.Measurements and results From data obtained at admission and at 48 h after admission, scores were calculated using the following scoring systems: Acute Physiology and Chronic Health Evaluation (APACHE) II and III, Scale for Composite Clinical and Laboratory Index Scoring (CCLI), Mayo Risk Score, and Child's Classification. Statistical analysis for the prognostic variables was performed using the chi-square test,t-test, Youden index, and area under a receiver operating characteristic (ROC) curve. APACHE III was found to be the most reliable outcome predictor at admission and after 48 h for patients with decompensated liver cirrhosis (AUC=0.75 and 0.8, respectively).Conclusions To predict the outcome for patients with decompensated cirrhosis of the liver admitted to a medical ICU liver failure alone is not decisive. Liver-specific scoring systems (Mayo Risk Score, CCLI) are adequate, but the APACHE II and III proved to be more powerful, because they include additional physiologic parameters and therefore also take into account additional complications associated with this liver disorder.     

The influence of length of stay in the ICU on power of discrimination of a multipurpose severity score (SAPS)

Objective To assess how the power of discrimination of a multipurpose severity score (Simplified Acute Physiology Score; SAPS) changes in relation to the length of stay (LOS) in the intensive care unit (ICU).Design In order to compute the SAPS probability, a model derived from logistic regression was developed in a cohort of 8059 patients. Measures of calibration (goodness-of-fit statistics) and discrimination [receiver operating characteristic (ROC) curve and relative area under the curve (AUC)] were adopted in a developmental set (5389 patients) and a validation set (2670 patients), both randomly selected. Once the logit was developed and the model validated, the whole database (8059 patients) was again assembled. To evaluate the accuracy of first-day SAPS probability over time, area under the ROC curve was computed for each of the initial 10 days of ICU care and for day 15.Setting 24 Italian ICUs.Patients A total of 8059 patients out of 10065 consecutive admissions over a period of 3 years (1990–1992) were included in this study. Patients whose SAPS was not correctly compiled (n=687), patients younger than 18 years (n=442), and patients whose LOS was less than 24 h (n=877) were excluded from this analysis.Interventions None.Measurements and results The logistic model gave good results in terms of calibration and discrimination, both in the developmental set (goodness-of-fit:X ²=9.24,p=0.32; AUC=0.79±0.01) and in the validation set (goodness-of-fit:X ²=8.95,p=0.537; AUC=0.78±0.01). The AUC for the whole database showed a loss in discrimination closely related to LOS: 0.79±0.01 at a day 1 and 0.59±0.02 at day 15.Conclusion The logistic model that we developed meets high standards for discrimination and calibration. However, SAPS loses its discriminative power over time; accuracy of prediction is maintained at an acceptable level only in patients who stay in the ICU no longer than 5 days. The stay in the ICU represents a complex variable, which is not predictable, that influences the performance of SAPS on the first day.ARCHIDIA (Archivio Diagnostico): A complete list of study participants appears in theAppendix     

Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study

Introduction  

Anemia among the critically ill has been described in patients with short to medium length of stay (LOS) in the intensive care unit (ICU), but it has not been described in long-stay ICU patients. This study was performed to characterize anemia, transfusion, and phlebotomy practices in patients with prolonged ICU LOS.     

早期肌钙蛋白I对危重孕产妇重症监护病房住院时间的预测价值

目的评估入重症监护病房（ICU）早期出现肌钙蛋白I（TnI）升高对重症孕产妇ICU住院时间的预测价值。 方法对2014年1月1日至2019年7月1日入住北京大学人民医院ICU的危重孕产妇的临床资料进行回顾性分析。根据入住ICU住院时间是否大于72 h,分为ICU住院时间延长和ICU住院时间非延长2个组。采用多因素Logistic回归方法分析ICU住院时间延长的独立危险因素。采用受试者工作特征（ROC）曲线评价入ICU早期TnI水平及AKI对ICU住院时间延长的预测价值。 结果本研究纳入转入ICU的危重孕产妇119例;其中ICU住院时间延长组47例（39.5%）,非延长组72例（60.5%）。Logistic回归分析发现,早期TnI升高（优势比6.697,95%CI：1.27~35.332,P=0.025）和急性肾损伤（AKI,优势比6.054,95%CI：1.248~29.368,P=0.025）是危重孕产妇ICU住院时间延长的独立危险因素。ROC曲线分析显示,入ICU早期发生TnI升高及AKI对ICU住院时间延长预测的曲线下面积分别为0.741（95%CI 0.65~0.832,P<0.001）和0.729（95%CI 0.634~0.825,P<0.001）;二者联合对ICU住院时间延长预测的曲线下面积为0.806（95%CI 0.723~0.889,P<0.001）。 结论早期出现TnI升高和AKI是预测危重孕产妇ICU住院时间延长的独立危险因素,对ICU住院时间有预测价值。     

Prognostic value of SAPS II and APACHE II scales in patients with multiple organ failure syndrome during early postoperative period after oncological surgery

The key fixed task was the following: detection, as soon as possible, of patients with a high risk of lethal outcome; an objective assessment of the condition of patients during the early postoperative period by using a quantitative evaluation (SAPS II, APACHE II); and defining of the prognostic value of SAPS II and APACHE II after oncology surgeries. The in-hospital lethality amounted to 53% in 73 patients with MOFS during the early postoperative period after oncology surgeries. The formalized (numerical) score, according to SAPS II and APACHE II, made it possible to detect patients with a higher risk of lethal outcome yet during the very first day after oncology surgeries. If the score of SAPS II or APACHE II topped 30 (on the first day after surgery), then the in-hospital lethality exceeded 50%. The information density of the SAPS II and APACHE II systems turned out to be identical, however, SAPS II appears to be more convenient in terms of practical usage since it demands the evolution of a smaller number of physiological parameters.     

Conflict in the care of patients with prolonged stay in the ICU: types,sources, and predictors

Objective To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.Design and setting We prospectively identified conflicts by interviewing treating physicians and nurses at two stages during the patients' stays. We then classified conflicts by type and source and used a case-control design to identify predictors of team-family conflicts.Design and setting Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.Patients All patients admitted to the participating ICUs over an 11-month period whose stay exceeded the 85th percentile length of stay for their respective unit (n=656).Measurements and results Clinicians identified 248 conflicts involving 209 patients; hence, nearly one-third of patients had conflict associated with their care: 142 conflicts (57%) were team-family disputes, 76 (31%) were intrateam disputes, and 30 (12%) occurred among family members. Disagreements over life-sustaining treatment led to 63 team-family conflicts (44%). Other leading sources were poor communication (44%), the unavailability of family decision makers (15%), and the surrogates' (perceived) inability to make decisions (16%). Nurses detected all types of conflict more frequently than physicians, especially intrateam conflicts. The presence of a spouse reduced the probability of team-family conflict generally (odds ratio 0.64) and team-family disputes over life-sustaining treatment specifically (odds ratio 0.49).Conclusions Conflict is common in the care of patients with prolonged stays in the ICU. However, efforts to improve the quality of care for critically ill patients that focus on team-family disagreements over life-sustaining treatment miss significant discord in a variety of other areas.Funding for this study was provided by the Harvard Risk Management Foundation. D.M.S. was also supported in part by grant number KO2HS11285 from the Agency for Healthcare Research and Quality.     

Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h

In most databases used to build general severity scores the median duration of intensive care unit (ICU) stay is less than 3 days. Consequently, these scores are not the most appropriate tools for measuring prognosis in studies dealing with ICU patients hospitalized for more than 72 h. PURPOSE: To develop a new prognostic model based on a general severity score (SAPS II), an organ dysfunction score (LOD) and evolution of both scores during the first 3 days of ICU stay. DESIGN: Prospective multicenter study. SETTING: Twenty-eight intensive care units (ICUs) in France. PATIENTS: A training data-set was created with four ICUs during an 18-month period (893 patients). Seventy percent of the patients were medical (628) aged 66 years. The median SAPS II was 38. The ICU and hospital mortality rates were 22.7% and 30%, respectively. Forty-seven percent (420 patients) were transferred from hospital wards. In this population, the calibration (Hosmer-Lemeshow chi-square: 37.4, P = 0.001) and the discrimination [area under the ROC curves: 0.744 (95 % CI: 0.714-0.773)] of the original SAPS II were relatively poor. A validation data set was created with a random panel of 24 French ICUs during March 1999 (312 patients). MEASUREMENTS AND MAIN RESULTS: The LOD and SAPS II scores were calculated during the first (SAPS1, LOD1), second (SAPS2, LOD2), and third (SAPS3, LOD3) calendar days. The LOD and SAPS scores alterations were assigned the value "1" when scores increased with time and "0" otherwise. A multivariable logistic regression model was used to select variables measured during the first three calendar days, and independently associated with death. Selected variables were: SAPS II at admission [OR: 1.04 (95 % CI: 1.027-1.053) per point], LOD [OR: 1.16 (95 % CI: 1.085-1.253) per point], transfer from ward [OR: 1.74 (95 % CI: 1.25-2.42)], as well as SAPS3-SAPS2 alterations [OR: 1.516 (95 % CI: 1.04-2.22)], and LOD3-LOD2 alterations [OR: 2.00 (95 % CI: 1.29-3.11)]. The final model has good calibration and discrimination properties in the training data set [area under the ROC curve: 0.794 (95 % CI: 0.766-0.820), Hosmer-Lemeshow C statistic: 5.56, P = 0.7]. In the validation data set, the model maintained good accuracy [area under the ROC curve: 0.826 (95 % CI: 0.780-0.867), Hosmer-Lemeshow C statistic: 7.14, P = 0.5]. CONCLUSIONS: The new model using SAPS II and LOD and their evolution during the first calendar days has good discrimination and calibration properties. We propose its use for benchmarking and evaluating the over-risk of death associated with ICU-acquired nosocomial infections.     

综合性三甲医院急诊室抢救患者滞留状况的研究

目的调查某家综合性三甲医院抢救患者在急诊室的滞留状况,为进一步加快急诊抢救患者的分流,提高急诊服务质量提供依据。方法使用急诊预检分诊数据库,回顾性调查分析某综合性三甲医院2010年全年急诊室抢救患者的相关信息,包括不同月份、不同科室、不同去向抢救患者的滞留时间及可能的原因。结果①该院全年7966例抢救患者在急诊室滞留的时间为0.5～2998 h,中位数10 h（四分位数3～23 h）;②不同月份抢救患者的滞留时间比较差异有统计学意义（χ2=22.869,P=0.018）,其中2月份最短,5月份最长;③患者对急诊抢救室床位占用时间最长的4个科室依次为急诊内科、神经外科、神经内科和急诊科,合计达91.8%的总床位占用时间。患者在急诊抢救室滞留时间最长的4位科室依次为急诊内科、神经内科、神经外科和胸外科;④不同去向的抢救患者滞留时间比较差异有统计学意义（χ2=731.471,P〈0.0001）,其中以直接住院和自动出院患者的滞留时间最长;⑤滞留时间24 h以上的抢救患者中,83.4%与相应的专科病房无床有关。结论该家医院急诊室抢救患者的滞留状况比较严重,其中急诊内科、神经内科、神经外科3个科室尤为严重,主要与相应专科的病房床位供应不足有关,医院有必要采取相应的对策。     

Prevalence of endotoxemia after surgery and its association with ICU length of stay

Introduction

The aim of this observational study was to investigate the prevalence of endotoxemia after surgery and its association with ICU length of stay.

Methods

102 patients admitted to a university ICU after surgery were recruited. Within four hours of admission, functional data were collected and APACHE II severity score calculated. Arterial blood samples were taken and endotoxemia was measured by chemiluminescence (Endotoxin Activity (EA)). Patients were stratified according to their endotoxin levels (low, intermediate and high) and according to their surgical procedures. Differences between endotoxin levels were assessed by ANOVA, accepting P < 0.05 as significant. Data are expressed as mean ± SD.

Results

EA levels were low in 68 (66%) patients, intermediate in 17 (17%) and high in 17 (17%). Age (61 ± 17 years) and APACHE II score 8.3 ± 3.7 (P = 0.542) were not significantly different in the three EA groups. Functional parameters on admission were similar between EA groups: white blood cells 11093 ± 4605 cells/mm³ (P = 0.385), heart rate 76 ± 16 bpm (P = 0.898), mean arterial pressure 88.8 ± 13.6 mmHg (P = 0.576), lactate 1.18 ± 0.77 mmol/L (P = 0.370), PaO₂/FiO₂ 383 ± 109 mmHg (P = 0.474). Patients with high levels of EA were characterized by longer length of stay in the ICU: 1.9 ± 3.0 days in the low EA group, 1.8 ± 1.4 days in intermediate and 5.2 ± 7.8 days in high group (P = 0.038).

Conclusions

17% of our patients were characterized by high levels of endotoxemia as assessed by EA assay, despite their low level of complexity on admission. High levels of endotoxin were associated with a longer ICU length of stay.     

Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems

Objective: To compare the Acute Physiology, Age and Chronic Health Evaluation (APACHE) III with the Simplified Acute Physiology Score (SAPS II) in discriminating in-hospital mortality for intensive care unit (ICU) patients with acute myocardial infarction (AMI). Design: Prospective, observational, multicenter study. Setting: 70 Spanish ICUs. Patients and participants: 1711 patients with AMI and representative of Spanish ICUs. Measurements and results: APACHE III score, APACHE III system probability of death (APACHE III probability), SAPS II score and in-hospital mortality were noted for each patient. Two hundred and twenty three (13.0 %) patients died in the hospital. The sensitivity (± SE), specificity (± SE), and accuracy (± SE) for the APACHE III score were, respectively, 75.8 ± 2.9, 75.9 ± 1.1, and 75.9 ± 1.0. The corresponding figures for APACHE III probability were 75.3 ± 2.9, 79.2 ± 1.1, and 78.7 ± 1.0, and for SAPS II 72.2 ± 3.0, 75.9 ± 1.1, and 75.4 ± 1.0. Conclusions: The results indicate good discrimination by the three tests. APACHE III probability shows a statistically significant improvement in accuracy and specificity when compared with the two scores. Received: 4 July 1996 Accepted: 27 November 1996