ABSTRACT
BACKGROUND: The Simplified Acute Physiology Score (SAPS) 3 has recently been developed, but not yet validated in surgical intensive care unit (ICU) patients. We compared the performance of SAPS 3 with SAPS II and the Acute Physiology and Chronic Health Evaluation (APACHE) II score in surgical ICU patients. METHODS: Prospectively collected data from all patients admitted to a German university hospital postoperative ICU between August 2004 and December 2005 were analysed. The probability of ICU mortality was calculated for SAPS II, APACHE II, adjusted APACHE II (adj-APACHE II), SAPS 3, and SAPS 3 customized for Europe [C-SAPS3 (Eu)] using standard formulas. To improve calibration of the prognostic models, a first-level customization was performed, using logistic regression on the original scores, and the corresponding probability of ICU death was calculated for the customized scores (C-SAPS II, C-SAPS 3, and C-APACHE II). RESULTS: The study included 1851 patients. Hospital mortality was 9%. Hosmer and Lemeshow statistics showed poor calibration for SAPS II, APACHE II, adj-APACHE II, SAPS 3, and C-SAPS 3 (Eu), but good calibration for C-SAPS II, C-APACHE II, and C-SAPS 3. Discrimination was generally good for all models [area under the receiver operating characteristic curve ranged from 0.78 (C-APACHE II) to 0.89 (C-SAPS 3)]. The C-SAPS 3 score appeared to have the best calibration curve on visual inspection. CONCLUSIONS: In this group of surgical ICU patients, the performance of SAPS 3 was similar to that of APACHE II and SAPS II. Customization improved the calibration of all prognostic models.
Subject(s)
Health Status Indicators , Intensive Care Units/statistics & numerical data , Postoperative Care/methods , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care/methods , Epidemiologic Methods , Female , Germany , Humans , Length of Stay , Male , Middle Aged , Prognosis , Treatment Outcome , Young AdultABSTRACT
The goal of this review is to demonstrate the steps and the main items of the cognitive process used by doctors in clinical reasoning of diagnostic and therapeutic decisions. The clinical problem-solving process makes use of the hypothetic deductive scientific method to solve problems. As soon as the doctor meets his (her) patient, many diagnostic hypotheses emerge in his (her) mind, which are evaluated and refuted or corroborated. The diagnostic decision occurs when a hypothesis reach a certain degree of likelihood. The therapeutic decision is based on the intended objectives and the waited effectiveness among many available alternatives.
Subject(s)
Clinical Competence , Problem Solving , Cognition , Humans , Patient Care Planning , Patient Education as TopicABSTRACT
O objetivo desta revisao é expor as fases e os principais constituintes do processo cognitivo que os médicos empregam no raciocínio clínico das decisoes diagnósticas e terapêuticas. O processo de soluçao dos problemas clínicos utiliza-se do método científico hipotético-dedutivo de resolver problemas. Tao logo um médico encontra um paciente, várias hipóteses diagnósticas surgem-lhe na mente, as quais sao avaliadas e refutadas ou corroboradas. A decisao diagnóstica é realizada quando uma hipótese atinge um certo grau de verossimilhança. A decisao terapêutica depende dos objetivos pretendidos e da efetividade esperada entre as diversas alternativas disponíveis.