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Background  Mortality prediction is important in intensive care. The  S implified  A cute  P hysiology  S core ( SAPS )  II  is a tool for predicting such mortality. However, the original  SAPS II  is poorly calibrated to current intensive care unit ( ICU ) populations because it draws on data, which is more than 20 years old. We aimed to improve the calibration of  SAPS II  using data from the  N orwegian  I ntensive  C are  R egistry ( NIR ). This is the first recalibration of  SAPS II  for Nordic data.    Methods  A first‐level customization was applied to improve calibration of the original  SAPS II  model (Model  A ).  NIR  data used covered more than 90% of adult patients admitted to  ICUs  in  N orway from 2008 to 2010 ( n  = 30712).    Results  The modified  SAPS II , Model  B , outperformed the original Model  A  with respect to calibration. Model  B  gave more accurate predictions of mortality than Model  A  ( H osmer– L emeshow's  C : 22.01 vs. 689.07; Brier score: 0.120 vs. 0.131;  C ox's calibration regression: α = −0.093 vs. −0.747, β = 0.921 vs. 0.735, (α|β = 1) = −0.009 vs. −0.630). The standardized mortality ratio was 0.73 [95% confidence interval ( CI ) of 0.70–0.76] for Model  A  and 0.99 (95%  CI  of 0.95–1.04) for Model  B . Discrimination was good for both models (area under receiver operating characteristic curve = 0.83 for both models).    Conclusions  As expected, Model  B  is better calibrated than Model  A , and both models have similar uniformity of fit and equal discrimination. Introducing Model  B  into Norwegian  ICUs  may improve precision in decision‐making. Units will have a more realistic benchmark for the assessment of  ICU  performance. Mortality risk estimates from Model  B  are better than previous  SAPS II  estimates have been.

A calibration study of SAPS II with Norwegian intensive care registry data