We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Modeling the Severity of Illness of ICU Patients A Systems Update

Stanley Lemeshow, PhD; Jean-Roger Le, MD
JAMA. 1994;272(13):1049-1055. doi:10.1001/jama.1994.03520130087038.
Text Size: A A A
Published online


Objective.  —To review recent revisions of systems for estimating the probability of hospital mortality of adult intensive care unit (ICU) patients. Emphasis on comparison of components of systems and potential uses.

Data Sources.  —Published articles in which the systems were presented.

Study Selection.  —Acute Physiology and Chronic Health Evaluation (APACHE III), Simplified Acute Physiology Score (SAPS II), and Mortality Probability Models (MPM II) are the major severity systems for ICU patients.

Data Extraction.  —Information on variables collected in the systems, characteristics of databases from which they were developed, and reported performance of models were evaluated from published articles.

Data Synthesis.  —APACHE III and SAPS II produce a score and probability of hospital mortality based on worst values of several variables during the first 24 hours in ICU. The MPM II system has four models, one at ICU admission and one at 24, 48, and 72 hours into the ICU stay. The SAPS II and MPM II models can be implemented from published information. The APACHE III score can be calculated from published information; weights to convert score to probability are proprietary. All reported good areas under receiver operating characteristic curve. Goodness of fit was good for SAPS II and MPM II models and was not reported for APACHE III models.

Conclusions.  —All models were based on rigorous research and reported performance is good. All can be used to assist in assessing prognosis, to compare ICU performance, and to stratify patients for clinical trials. Direct comparison on a common cohort is needed.(JAMA. 1994;272:1049-1055)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.