McAnena O J, Moore F A, Moore E E, Mattox K L, Marx J A, Pepe P
Department of Surgery, Denver General Hospital, CO 80204-4507.
J Trauma. 1992 Oct;33(4):504-6; discussion 506-7. doi: 10.1097/00005373-199210000-00003.
The APACHE II scoring system has been promulgated as a useful tool in the assessment of the severity of injury and prognosis for acutely ill patients. The physiologic basis for stratification is weighted toward older patients with chronic medical conditions. Recently, the APACHE II system has been proposed as a method for determining diagnosis related group (DRG) reimbursement for individual trauma patients. The present study applied the APACHE II scoring system to 280 patients with blunt or penetrating trauma who had documented systolic blood pressure < 90 mm Hg. Fifty-seven (20%) died of their injuries within the first 24 hours. APACHE II scores were recorded both in the emergency room (ED) and at 24 hours following admission. Injury Severity Scores (ISS), Revised Trauma Scores (RTS), and TRISSCAN were calculated. The APACHE II (n = 223) recorded at 24 hours (2.5 +/- 0.2) was significantly less than that recorded in the ED (6.6 +/- 0.3, p < 0.05, Mann-Whitney analysis). Using regression analysis, there was no correlation between APACHE II and ISS if recorded in the ED (r2 = 0.06) or 24 hours following admission (r2 = 0.08). APACHE II also demonstrated a poor correlation with the length of hospital stay (r2 = 0.03 [ED], = 0.19 [24 hours]). Whereas APACHE II may be helpful in defining severity of disease among patients with acute-on-chronic medical conditions, the classification lacks an anatomic component, which is essential to assess the magnitude of acute injury in patients who are typically otherwise healthy.
急性生理学及慢性健康状况评分系统（APACHE II）已被公布为评估急性病患者损伤严重程度和预后的有用工具。分层的生理基础对患有慢性疾病的老年患者更为有利。最近，APACHE II系统被提议作为确定个体创伤患者诊断相关组（DRG）报销费用的一种方法。本研究将APACHE II评分系统应用于280例收缩压记录<90 mmHg的钝性或穿透性创伤患者。57例（20%）在最初24小时内死于损伤。在急诊室（ED）和入院后24小时均记录了APACHE II评分。计算了损伤严重程度评分（ISS）、修订创伤评分（RTS）和TRISSCAN。24小时记录的APACHE II评分（n = 223，2.5±0.2）显著低于急诊室记录的评分（6.6±0.3，p < 0.05，Mann-Whitney分析）。使用回归分析，如果在急诊室记录（r2 = 0.06）或入院后24小时记录（r2 = 0.08），APACHE II与ISS之间无相关性。APACHE II与住院时间的相关性也较差（r2 = 0.03 [急诊室]，r2 = 0.19 [24小时]）。虽然APACHE II可能有助于界定患有慢性基础疾病的急性病患者的疾病严重程度，但该分类缺乏解剖学成分，而解剖学成分对于评估通常原本健康的患者的急性损伤程度至关重要。
