Cho D Y, Wang Y C, Lee M J
Division of Neurosurgery, Taichung Veterans General Hospital, Yang-Ming Medical University, Taiwan, China.
Clin Intensive Care. 1995;6(1):9-14.
This study examined the efficacy of predicting power for hospital mortality of three different scoring systems in a neurosurgical intensive care unit (NICU).
An eight-bed NICU in a 1,270-bed medical centre (Taichung Veterans General Hospital).
Two hundred patients with head injury, brain tumour, hypertensive intracerebral haemorrhage, rupture of aneurysm or arteriovenous malformation, or other categories were included in our study in a consecutive period of 14 months. Patients less than 14 years old were not included.
On the first day of admission, data were collected from each patient to compute the Acute Physiology and Chronic Health (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as when death occurred before discharge from hospital.
none.
Sensitivity, specificity and correct prediction outcomes were measured by logistic regression in three scoring systems. The Youden index was also obtained. The best cutoff point in each scoring system was determined by logistic regression or by the Youden index. Data obtained by logistic regression were compared by McNemar's test. The differences in Youden index were calculated by the Student's t-test. The area under the Receiver Operating Characteristic (ROC) curve was computed and the area of each scoring system was then compared by the Wilcoxon Mann-Whitney test.
The correct prediction of outcome was 85.5% in APACHE III, 77.5% in APACHE II and 75.0% in GCS. The area under the Receiver Operating Characteristic (ROC) curve was 0.892 in APACHE III, 0.826 in APACHE II and 0.868 in GCS. For the prediction of dead patients at the best cutoff point, APACHE III and GCS were better than APACHE II, (both p < 0.01 respectively). For the prediction of alive patients at the best cutoff point, APACHE III was better than GCS and APACHE II (p < 0.01 respectively).
The APACHE III system seems to be the most reliable. The results reveal that the APACHE III system is better in predicting power for hospital mortality than either the GCS or APACHE II systems in our NICU patients.
本研究考察了三种不同评分系统对神经外科重症监护病房（NICU）患者医院死亡率的预测效能。
台中荣民总医院，一家拥有1270张床位的医疗中心内的一个八床位NICU。
在连续14个月的时间里，纳入了200例头部受伤、脑肿瘤、高血压性脑出血、动脉瘤或动静脉畸形破裂或其他病症的患者。不包括14岁以下的患者。
入院第一天，收集每位患者的数据以计算急性生理与慢性健康状况（APACHE）II和III评分以及格拉斯哥昏迷量表（GCS）评分。医院死亡率定义为在出院前死亡。
无。
通过逻辑回归在三种评分系统中测量敏感性、特异性和正确预测结果。还获得了约登指数。每个评分系统的最佳截断点通过逻辑回归或约登指数确定。通过McNemar检验比较逻辑回归获得的数据。通过学生t检验计算约登指数的差异。计算受试者工作特征（ROC）曲线下面积，然后通过Wilcoxon Mann-Whitney检验比较每个评分系统的面积。
APACHE III对结果的正确预测率为85.5%，APACHE II为77.5%，GCS为75.0%。APACHE III的受试者工作特征（ROC）曲线下面积为0.892，APACHE II为0.826，GCS为0.868。在最佳截断点预测死亡患者时，APACHE III和GCS优于APACHE II（p值均分别<0.01）。在最佳截断点预测存活患者时，APACHE III优于GCS和APACHE II（p值均分别<0.01）。
APACHE III系统似乎是最可靠的。结果表明，在我们的NICU患者中，APACHE III系统在预测医院死亡率方面比GCS或APACHE II系统更好。
