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用于预测急诊科危重症患者院内死亡率的经验证的生理评分系统的运行性能。

Operational performance of validated physiologic scoring systems for predicting in-hospital mortality among critically ill emergency department patients.

作者信息

Jones Alan E, Fitch Michael T, Kline Jeffrey A

机构信息

Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.

出版信息

Crit Care Med. 2005 May;33(5):974-8. doi: 10.1097/01.ccm.0000162495.03291.c2.

DOI:10.1097/01.ccm.0000162495.03291.c2

PMID:15891323

Abstract

OBJECTIVES

New Simplified Acute Physiology Score (SAPS) II, Morbidity Probability Model at admission (MPM0 II), and Logistic Organ Dysfunction System (LODS) have all demonstrated high accuracy for predicting mortality in intensive care unit populations. We tested the prognostic accuracy of these instruments for predicting mortality among a cohort of critically ill emergency department patients.

DESIGN

Secondary analysis of a randomized controlled trial.

SETTING

Urban, tertiary emergency department, census >100,000.

PATIENTS

Nontrauma emergency department patients admitted to an intensive care unit, aged >17 yrs, with initial emergency department vital signs consistent with shock (systolic blood pressure <100 mm Hg or shock index >1.0), and with agreement of two independent observers for at least one sign and symptom of inadequate tissue perfusion.

INTERVENTIONS

Emergency department variables needed for calculation of each scoring system were prospectively collected, and published formulas were used to calculate the probability of in-hospital death for each scoring system. The main outcome was actual in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each scoring system.

MEASUREMENTS AND MAIN RESULTS

Ninety-one of 202 patients (45%) were included. The mean age was 56 +/- 16 yrs, 42% were female, the mean initial systolic blood pressure was 84 +/- 13 mm Hg, and the average length of stay in the emergency department was 4.2 +/- 2.0 hrs. The in-hospital mortality rate was 21%. The area under the receiver operating characteristic curve for calculated probability of in-hospital mortality for SAPS II was 0.72 (95% confidence interval, 0.57-0.87), for MPM0 II 0.69 (95% confidence interval, 0.54-0.84), and for LODS 0.60 (95% confidence interval, 0.45-0.76).

CONCLUSIONS

Using variables available in the emergency department, three previously validated intensive care unit scoring systems demonstrated moderate accuracy for predicting in-hospital mortality.

摘要

目的

新简化急性生理学评分系统（SAPS）II、入院时发病概率模型（MPM0 II）和逻辑器官功能障碍系统（LODS）在预测重症监护病房患者死亡率方面均显示出较高的准确性。我们测试了这些工具在预测一组危重症急诊科患者死亡率方面的预后准确性。

设计

对一项随机对照试验进行二次分析。

地点

城市三级急诊科，人口普查超过10万。

患者

入住重症监护病房的非创伤性急诊科患者，年龄>17岁，急诊科初始生命体征与休克相符（收缩压<100 mmHg或休克指数>1.0），且两名独立观察者对至少一项组织灌注不足的体征和症状达成一致。

干预措施

前瞻性收集计算每个评分系统所需的急诊科变量，并使用公布的公式计算每个评分系统的院内死亡概率。主要结局为实际院内死亡率。采用受试者工作特征曲线下面积评估每个评分系统的预测能力。

测量与主要结果

202例患者中有91例（45%）纳入研究。平均年龄为56±16岁，42%为女性，平均初始收缩压为84±13 mmHg，急诊科平均住院时间为4.2±2.0小时。院内死亡率为21%。SAPS II计算的院内死亡概率的受试者工作特征曲线下面积为0.72（95%置信区间，0.57 - 0.87），MPM0 II为0.69（95%置信区间，0.54 - 0.84），LODS为0.60（95%置信区间，0.45 - 0.76）。