Adjustierung und Optimierung des SAPS II anhand des Nationalregisters der DIVI

This dissertation is dealing with the specific adaption of SAPS II (Simplified Acute Physiology Score II) to the aims and purposes of the section quality assurance of DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin). SAPS II represents the succession of SAPS and serves for disease severity based on physiologic information and calculates the probability of death. Since, for the first introduction of SAPS II 19 years before, it has to be adapted to the current circumstances. In this study SAPS II was modified. Among others new parameter like admission from external clinics, trauma, sex, neuro and faculty added to SAPS II. The GCS (Glasgow Coma Scale) which was originally included in SAPS II was ignored because of high observer variation at sedated and ventilated patients. Instead of GCS neurologic respectively neurosurgical patients were considered to take neurologic status into account. Moreover original SAPS II computed prognosis refers to hospital-outcome, in contrast to SAPS-DIVI 2 calculating refers to intensive care unit outcome. From the new variables especially admission from external clinics was associated with high influence on mortality, and therefore it should be integrated in SAPS II. Furthermore, age and type of admission are playing an important role in mortality of SAPS II. The variables trauma and sex however do not play an important role in estimating death in SAPS II. SAPS II is a score which reflects the degree of disease severity and for this reason it is a useful tool for subjective-emotional decisions, therefore it can be used as a support for medical decisions. To uphold the validity of SAPS II over the years it has to be regularly adapted to the current circumstances by continuous improving quality criteria or by modification of the score-system with introducing a new score-model, namely SAPS 3.