Some ICUs save more lifes than others: we need to know why!

Excerpt

For 25 years the early prediction of hospital mortality has been investigated extensively in ICU patients. Assessment of preexisting morbidities and acute physiological derangements have resulted in risk-adjusted outcomes allowing patient classification according to severity of disease. This permitted the effects of different treatment regimens to be compared more appropriately by taking into account the presence of chronic disease states together with the importance of acute organ dysfunction at the beginning of therapy. In addition, comparison of outcome with risk adjustment has also been attempted between different ICUs and between countries [1]. The first generation of these severity scores was published more than 20 years ago—APACHE I and II, SAPS I in 1981–1985 [2, 3, 4]—followed by the second generation 10 years later—APACHE III, SAPS II, MPM II in 1991–1993 [1, 5, 6]. Ten years later the third generation of these tools is knocking at the door. In Intensive Care Medicine Metnitz, Moreno, and their colleagues [7, 8] now report on the promising SAPS 3 system. …