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Jean-Roger Le Gall, MD; Stanley Lemeshow, PhD; Fabienne Saulnier, MD

JAMA. 1993;270(24):2957-2963.

Abstract
Objective.
—To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality.

Design and Setting.
—The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries.

Patients.
—The 13 152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded.

Outcome Measure.
—Vital status at hospital discharge.

Results.
—The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P=.883 and P=.104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample.

Conclusion.
—The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units.

(JAMA. 1993;270:2957-2963)

Author Affiliations
From the Faculty of Medicine Lariboisière-Saint-Louis, Paris, France (Dr Le Gall); the School of Public Health, University of Massachusetts, Amherst (Dr Lemeshow); and The Evaluation Center of Lille (France) (Dr Saulnier).

Footnotes
A complete list of study participants appears at the end of this article.

Reprint requests to Service de Réanimation Médicale, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, France 75010 (Dr Le Gall).

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