Thwaites C L, Yen L M, Glover C, Tuan P Q, Nga N T N, Parry J, Loan H T, Bethell D, Day N P J, White N J, Soni N, Farrar J J
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Trop Med Int Health. 2006 Mar;11(3):279-87. doi: 10.1111/j.1365-3156.2006.01562.x.
To create a new tetanus score and compare it with the Phillips and Dakar scores.
We used prospectively acquired data from consecutive patients admitted to the Hospital for Tropical Diseases, Ho Chi Minh City, to create the Tetanus Severity Score (TSS) with multivariate logistic regression. We compared the new score with Phillips and Dakar scores by means of resubstituted and prospective data, assessing performance in terms of sensitivity, specificity and area under receiver operator characteristic curves.
Resubstitution testing yielded a sensitivity of 77% (298/385) and a specificity of 82% (1,183/1,437) for the TSS; 89% (342/385) and 20% (281/1,437) for the Phillips score; and 13% (49/385) and 98% (1,415/1,437) for the Dakar score. The TSS showed greatest discrimination with 0.89 area under the receiver operator characteristic curve (95% CI 0.88-0.90); this was 0.74 for the Dakar score and (95% CI 0.71-0.77) and 0.66 for the Phillips score (95% CI 0.63-0.70; P values <0.001). Prospective testing showed 65% (13/20) sensitivity and 91% (210/230) specificity for the TSS; 80% (16/20) and 51% (118/230) for the Phillips score; and 25% (5/20) and 96% (221/230) for the Dakar score. The TSS achieved the greatest area under TSS of 0.89 (95% CI 0.82-0.96), significantly greater than the Phillips score [0.74 (0.6-0.88), P = 0.049] but not the Dakar score [0.80, (0.71-0.90), P = 0.090].
The TSS is the first prospectively developed classification scheme for tetanus and should be adopted to aid clinical triage and management and as a basis for clinical research.
创建一种新的破伤风评分系统，并将其与菲利普斯评分和达喀尔评分进行比较。
我们前瞻性地收集了胡志明市热带病医院连续入院患者的数据，通过多变量逻辑回归创建破伤风严重程度评分（TSS）。我们通过重新代入数据和前瞻性数据，将新评分与菲利普斯评分和达喀尔评分进行比较，从敏感性、特异性和受试者工作特征曲线下面积方面评估其性能。
重新代入测试得出TSS的敏感性为77%（298/385），特异性为82%（1183/1437）；菲利普斯评分的敏感性为89%（342/385），特异性为20%（281/1437）；达喀尔评分的敏感性为13%（49/385），特异性为98%（1415/1437）。TSS在受试者工作特征曲线下面积最大，为0.89（95%可信区间0.88 - 0.90）；达喀尔评分为0.74（95%可信区间0.71 - 0.77），菲利普斯评分为0.66（95%可信区间0.63 - 0.70；P值<0.001）。前瞻性测试显示TSS的敏感性为65%（13/20），特异性为9%（210/230）；菲利普斯评分的敏感性为80%（16/20），特异性为51%（118/230）；达喀尔评分的敏感性为25%（5/20），特异性为96%（221/230）。TSS在受试者工作特征曲线下面积最大，为0.89（95%可信区间0.82 - 0.96），显著大于菲利普斯评分[0.74（0.6 - 0.88），P = 0.049]，但不大于达喀尔评分[0.80，（0.71 - 0.90），P = 0.090]。
TSS是首个前瞻性开发的破伤风分类方案，应被采用以辅助临床分诊和管理，并作为临床研究的基础。
