EuroSCORE II, illum qui est gravitates magni observe

Abstract

A Google search for EuroSCORE identifies at least 108 000 references and more than 1300 formal citations. The first versions have indeed been used and misused without an in-depth understanding of their limitations. EuroSCORE I has been used as a quality monitoring or comparison tool. The quality of care is largely dissociated with the early risk. Indeed, the quality of care in cardiac surgery procedures has to use extended observation intervals years beyond the observation interval of the EuroSCORE models. In addition, the quality of care involves a whole series of criteria as there are appropriate diagnostic systems, waiting times, early risks, late benefits, resources used ... EuroSCORE I has been used for differential therapy or informed consent forms to express the early risk to patient and society. This use was similarly inappropriate since the risk interval should be based on the observation of the hazard function and will vary for each pathology, each event, major variability in the procedure and in post-procedural approaches. EuroSCORE I therefore needed to use an observation interval including the observation intervals mandatory for all major pathologies and procedural approaches, included in its reference database. It failed to do so and therefore always presented an incorrect and incomplete depiction of this early risk. The dramatic misuse of the EuroSCORE for the TAVI (Transcatheter Aortic Valve Implantation) market expansion was also a mistake. There has never been any information about the density at this high-end of the risk spectrum of the original reference database, and even less information about discriminatory and calibration power within this zone of risk. A similar misuse has been the application of EuroSCORE I for early non-lethal events as renal failure or length of stay. Of course, there were some predictive values and some ROC values in amalgamating the more usual risk factors (even using an irrelevant coefficient), but this misuse rejected the complete notion of outcome analysis, its rules and limitations.