Gladman J R, Harwood D M, Barer D H
Department of Health Care of the Elderly, University Hospital, Nottingham.
J Neurol Neurosurg Psychiatry. 1992 May;55(5):347-51. doi: 10.1136/jnnp.55.5.347.
Five multivariate models designed to predict the outcome of stroke were tested prospectively on 102 consecutive stroke patients admitted to a district general hospital. The results were compared with predictions made using two simple clinical variables (the conscious level on admission and the state of urinary continence at four weeks). Of the three models (developed in Belfast, Guy's Hospital and Uppsala) intended for use in the acute stages of stroke the last two were slightly more accurate in their prediction of death (75%) than was the admission conscious level alone (65%), whereas the Belfast model had an accuracy of only 50% in this situation. At a later stage, the state of urinary continence predicted good and poor outcomes with similar accuracy to that of a multivariate model from Edinburgh. A model developed in Bristol performed poorly. When tested prospectively, these multivariate models proved considerably less accurate than when they were first described. Only the Uppsala model showed any advantage over simple clinical methods. This might be of value in defining prognostic strata for clinical studies, but not in the management of individual patients. Simple clinical variables thus offer as much to clinicians as complex multivariate models.
针对102例连续入住一家地区综合医院的中风患者，对旨在预测中风预后的五个多变量模型进行了前瞻性测试。将结果与使用两个简单临床变量（入院时的意识水平和四周时的尿失禁状态）所做的预测进行了比较。在旨在用于中风急性期的三个模型（分别在贝尔法斯特、盖伊医院和乌普萨拉开发）中，后两个模型对死亡的预测（75%）比仅入院时的意识水平（65%）略准确，而在这种情况下，贝尔法斯特模型的准确率仅为50%。在后期，尿失禁状态对预后好坏的预测准确率与爱丁堡一个多变量模型的相似。在布里斯托尔开发的一个模型表现不佳。经前瞻性测试，这些多变量模型的准确率比首次描述时低得多。只有乌普萨拉模型显示出比简单临床方法有任何优势。这可能在为临床研究确定预后分层方面有价值，但在个体患者的管理中则不然。因此，简单的临床变量为临床医生提供的信息与复杂的多变量模型一样多。
