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Eur J Cardiothorac Surg 2006;29:446
© 2006 Elsevier Science NL

Editorial comment

Papworth Hospital, Cambridge CB3 8 RE, United Kingdom

^_* Tel.: +44 1480 364299; fax: +44 1480 364744. (Email: sam.nashef{at}papworth.nhs.uk).

In this issue, Yap et al. [1] examine the performance of the additive and logistic EuroSCORE risk models in an Australian cardiac surgical population of over 8000 patients. To date, there have been papers which tested EuroSCORE in single-institution studies and some have reported that the model overpredicts risk. When this happens, true risk overprediction by the model may be the explanation, but other possibilities also exist. First, it is likely that those institutions with first-class data collection and robust audit mechanisms do in fact perform better than average, and such a study may tell us more about the excellent results of an institution than about the risk model itself. The second is publication bias: if you test EuroSCORE, or any other model, in your institution and find that your outcomes are not as good as predicted, you are less likely to wish to publicise the fact.

This paper by Yap et al. [1] is different: it has examined the EuroSCORE models in a multi-institutional recent study and found that the model significantly overpredicts risk and therefore has poor calibration in this study. To be fair to the model, however, the discrimination remains excellent with an area under the receiver operating characteristic curve (ROC) of 0.82–0.83.

The paper concludes that the model may not be applicable to Australian patients. This is being generous to the model because it may be equally likely that the reason for overprediction is that the model may now be out of date.

EuroSCORE has been a very successful European venture which has been well received worldwide. It is probably the most commonly used and cited surgical clinical risk model in medical history. However, the patients from whose data EuroSCORE was constructed were operated more than 10 years ago. The time has come for a repeat calibration. This should be preferably based on fresh data which should be of the same high quality as the original database.

The EuroSCORE project group will be reconvened soon to address these issues. Many questions will need to be answered about the shape and nature of the new data collection exercise. Input from all surgeons and epidemiologists with an interest in this field is welcome.

	References

Top References

 

1. Yap C-H, Reid C, Yii M, Rowland MA, Mohajeri M, Skillington PD, Seevanayagam S, Smith JA. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg 2006;29:114-116.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nashef, S.A.M. Search for Related Content PubMed Articles by Nashef, S.A.M.