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Current Gerontology and Geriatrics Research
Volume 2014, Article ID 934852, 9 pages
Review Article

The Simplified Acute Physiology Score III Is Superior to the Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II in Predicting Surgical and ICU Mortality in the “Oldest Old”

1Saint George’s University School of Medicine, West Indies, Grenada
2Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
3Department of Surgery, University of Medicine and Dentistry of New Jersey (UMDNJ), 94 Old Short Hills Road Livingston, Newark, NJ 07039, USA

Received 25 August 2013; Revised 3 November 2013; Accepted 2 December 2013; Published 17 February 2014

Academic Editor: Giuseppe Zuccala

Copyright © 2014 Aftab Haq et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Elderly patients in the USA account for 26–50% of all intensive care unit (ICU) admissions. The applicability of validated ICU scoring systems to predict outcomes in the “Oldest Old” is poorly documented. We evaluated the utility of three commonly used ICU scoring systems (SAPS II, SAPS III, and APACHE II) to predict clinical outcomes in patients > 90 years. 1,189 surgical procedures performed upon 951 patients > 90 years (between 2000 and 2010) were analyzed. SAPS II, SAPS III, and Acute APACHE II were calculated for all patients admitted to the SICU. Differences between survivors and nonsurvivors were analyzed using the Student’s t-test and binary logistic regression analysis. A receiver operating characteristic (ROC) curve was constructed for each scoring system studied. The area under the ROC curve (aROC) for the SAPS III was 0.81 at a cut-off value of 57, whereas the aROC for SAPS II was 0.75 at a cut-off score of 44 and the aROC for APACHE II was 0.74 at a cut-off score of 13. The SAPS III ROC curve for prediction of hospital mortality exhibited the greatest sensitivity (84%) and specificity (66%) with a score of 57 for the “Oldest Old” population.