Evaluation of an interdisciplinary data set for national intensive care unit assessment

Objectives: To evaluate the ability of an interdisciplinary data set (recen tly defined by the Austrian Working Group for the Standardization of a Docu mentation System for Intensive Care [ASDI]) to assess intensive care units (ICUs) by means of the Simplified Acute Physiology Score II (SAPS II) for t he severity of illness and the simplified Therapeutic Intervention Scoring System (TISS-28) for the level of provided care. Design: A prospective, multicentric study. Setting: Nine adult medical, surgical, and mixed ICUs in Austria. Patients: A total of 1234 patients consecutively admitted to the ICUs, Interventions: Collection of data for the ASDI data set. Measurements and Main Results: The overall mean SAPS II score was 33.1 +/- 2.1 points. SAPS II overestimated hospital mortality by predicting mortalit y of 22.2% +/- 2.9%, whereas observed mortality was only 16.8% +/- 2.2%. Th e Hosmer-Lemeshow goodness-of-fit test for SAPS II scores showed lacking un iformity of fit (H = 53.78, 8 degrees of freedom; p < .0001), TISS-28 score s were recorded on 8616 days (30.6 +/- 1.5 points). TISS-28 scores were hig her in nonsurvivors than in survivors (30.4 +/- 0.9 vs, 25.7 +/- 0.4, respe ctively; p < .05). No significant correlation between mean TISS-28 per pati ent per unit on the day of admission and mean predicted hospital mortality (r(2) = .23; p < .54) or standardized mortality ratio per unit (r(2) = -.22 ; p < .56) was found. Conclusions: Implementation of an interdisciplinary data set far ICUs provi ded data with which to evaluate performance in terms of severity of illness and provided care, The SAPS II did not accurately predict outcomes in Aust rian ICUs and must, therefore, be customized for this population. A combina tion of indicators for both severity of illness and amount of provided care is necessary to evaluate ICU performance. Further data acquisition is need ed to customize the SAPS II and to validate the TISS-28.