Specificity and reliability of prognostic indexes in intensive care evaluation: The spontaneous cerebral haemorrhage case

Objective To determine the reliability of a generic index such as Simplified Acute PhysiologyScore II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score(ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a generalfacility that frequently treats a specific type of patients – those with spontaneous cerebralhaemorrhage.Methods The study cohort consisted of a random sample of patients (81) admitted toModena’s Policlinico Teaching Hospital’s ICU with spontaneous ICH over a 24-monthperiod.Main outcome measure SAPSII, ICH score, overall mortality.Results The mean ICH score for the 32 surviving patients was 3.41 1.012 while forthe 49 deceased patientswas of 4.24 0.855 (P = 0.000). The mean SAPSII value for the 32surviving patientswas 49.09 16.58 while for the 49 deceased patientswas 49.51 15.93.SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves:the area under the curve was significant for ICH, not-significant for SAPSII.Conclusions Regional quality controls use generic prognostic indexes (SAPSII) in relationto mortality and outcome to assess ICUs, which is appropriate when dealing with ageneral facility when there is not a predominant type of patient, but it may bias theevaluation if the population with specific pathologies (ICH), not included in the generalindex, is statistically considerable, leading to an incorrect criticality assessment, an inappropriatestrategic plan and the subsequent inefficient resource allocation.