Does EuroSCORE work in individual European countries?
Roques F, Nashef SA, Michel P, Pinna Pintor P, David M, Baudet E, The
EuroSCORE Study Group.
Service de Chirurgie Cardio-vasculaire, CHU de Fort de France, 97200 Fort de
France, Martinique, France. firstname.lastname@example.org
OBJECTIVE: Because of national epidemiological differences in adult heart
surgery in Europe, the effectiveness and desirability of a pan-European
score for the assessment of quality of surgical care remains controversial.
We assessed the predictive value of EuroSCORE in national subsets of the
EuroSCORE database. METHODS: The EuroSCORE development data set was divided
into national subsets of which those with 500 or more patients were selected
for analysis. The Hosmer-Lemeshow goodness-of-fit test was applied to assess
the calibration of the EuroSCORE model on individual national samples and
the areas under the receiver operating characteristic (ROC) curve were
measured to analyse the EuroSCORE discriminative power on individual death
prediction. RESULTS: There were 18676 patients in the six largest national
samples: Germany, United Kingdom, Spain, Finland, France and Italy (mean:
3113 patients; range: Finland 1266 to France 4507). Major differences were
observed in national distribution of procedures: coronary artery bypass
grafting accounted for 77.7% of procedures in Finland but only 46.2% in
Spain. The EuroSCORE model goodness-of-fit was satisfactory in all countries
(P-value overall: 0.4; UK: 0.34; Finland: 0.87; no values less than 0.05).
Areas under ROC curves were 0.81 in Germany, 0.79 in the UK, 0.74 in Spain,
0.87 in Finland, 0.82 in France and 0.82 in Italy. CONCLUSION: Despite
epidemiological differences between European countries, the discriminative
power of EuroSCORE was good in Spain and excellent in all other countries.
The system, developed from a merged European database, can therefore be used
to assess improvement in quality of care achieved by surgeons and
institutions as well as for international European comparison in adult heart