Meyer A A, Messick W J, Young P, Baker C C, Fakhry S, Muakkassa F, Rutherford E J, Napolitano L M, Rutledge R
Department of Surgery, University of North Carolina, Chapel Hill 27599-7210.
J Trauma. 1992 Jun;32(6):747-53; discussion 753-4. doi: 10.1097/00005373-199206000-00013.
Prospective identification of patients who will not survive has been proposed as a means of limiting utilization of medical resources including critical care. This study prospectively compared prediction of outcome for surgical ICU patients by clinical assessment and the APACHE II score. Five hundred seventy-eight patients were assessed within 24 hours of admission by the ICU attending physician and predicted to live or die. An APACHE II score was calculated in that same time period. All data were stored in a data base and compared with actual SICU outcome. There were 40 deaths in 578 patients (6.9%). The clinical assessment had an overall accuracy of 95.2% vs. 90.9% for APACHE II. The Pearson correlation coefficients for the two methods of prediction were 0.59 for clinical assessment and 0.44 for APACHE II. Predictive power was not greatly improved by combining both prediction methods. Over 40% of patients predicted to die by both methods actually survived. This study demonstrates that clinical assessment is superior to APACHE II in predicting outcome in this group of surgical patients, although the difference is small. In addition, this study suggests that neither clinical assessment nor the APACHE II score, when obtained within 24 hours of admission, is very reliable at predicting which surgical ICU patients will die.
识别那些无法存活的患者并进行前瞻性研究，已被提议作为一种限制包括重症监护在内的医疗资源使用的手段。本研究前瞻性地比较了通过临床评估和急性生理学及慢性健康状况评分系统（APACHE II）对外科重症监护病房（ICU）患者的预后预测情况。578名患者在入院24小时内由ICU主治医生进行评估，并预测其生死情况。在同一时间段内计算APACHE II评分。所有数据存储在数据库中，并与外科ICU的实际预后情况进行比较。578名患者中有40人死亡（6.9%）。临床评估的总体准确率为95.2%，而APACHE II为90.9%。两种预测方法的皮尔逊相关系数，临床评估为0.59，APACHE II为0.44。将两种预测方法结合使用，预测能力并未得到显著提高。两种方法都预测会死亡的患者中，超过40%实际上存活了下来。本研究表明，在预测这组外科患者的预后方面，临床评估优于APACHE II，尽管差异较小。此外，本研究表明，在入院24小时内获得的临床评估或APACHE II评分，在预测哪些外科ICU患者会死亡方面都不是非常可靠。
