van den Bosch J E, Kalkman C J, Vergouwe Y, Van Klei W A, Bonsel G J, Grobbee D E, Moons K G M
Department of Perioperative Care and Emergency Medicine, University Medical Centre Utrecht, the Netherlands.
Anaesthesia. 2005 Apr;60(4):323-31. doi: 10.1111/j.1365-2044.2005.04121.x.
We have validated two scoring systems for predicting postoperative nausea and vomiting, derived by Apfel et al. and Koivuranta et al. from 1388 adult inpatients undergoing a wide range of surgical procedures. The predictive accuracy of the scoring systems was evaluated in terms of the ability to discriminate between patients with and without postoperative nausea and vomiting (discrimination) and agreement between observed and predicted outcomes (calibration). Discrimination and calibration were less than expected based on previous reports, with both scoring systems providing risk predictions that were too extreme. The area under the ROC curve was 0.63 for Apfel et al.'s scoring system and 0.66 for Koivuranta et al.'s scoring system. Neither of the scoring systems provided a risk threshold for administering anti-emetic prophylaxis that yielded satisfying results in terms of predictive values, sensitivity and specificity. Hence, in their original forms, the scoring systems do not guarantee accurate prediction of the risk of postoperative nausea and vomiting in other patient populations. Koivuranta et al.'s scoring system appears to be more robust across different populations.
我们验证了两种由阿佩尔等人和科伊武兰塔等人从1388名接受各种外科手术的成年住院患者中得出的预测术后恶心和呕吐的评分系统。根据区分术后恶心和呕吐患者与未出现该症状患者的能力（区分度）以及观察结果与预测结果之间的一致性（校准度），对评分系统的预测准确性进行了评估。与之前的报告相比，区分度和校准度均低于预期，两种评分系统给出的风险预测都过于极端。阿佩尔等人的评分系统的ROC曲线下面积为0.63，科伊武兰塔等人的评分系统为0.66。两种评分系统均未提供在预测值、敏感性和特异性方面能产生令人满意结果的抗呕吐预防用药风险阈值。因此，就其原始形式而言，这些评分系统不能保证准确预测其他患者群体术后恶心和呕吐的风险。科伊武兰塔等人的评分系统在不同人群中似乎更为稳健。
