Rohrbach Barton W, Buchanan Benjamin R, Drake Jennifer M, Andrews Frank M, Bain Fairfield T, Byars Douglas T, Bernard William V, Furr Martin O, Paradis Mary Rose, Lawler Jacquelin, Giguère Steeve, Dunkel Bettina
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA.
J Am Vet Med Assoc. 2006 Jun 1;228(11):1748-56. doi: 10.2460/javma.228.11.1748.
To create a mathematical model to assist in early prediction of the probability of discharge in hospitalized foals < or= 7 days old.
Prospective study.
1,073 foals.
Medical records from 910 hospitalized foals < or = 7 days old for which outcome was recorded as died or discharged alive were reviewed. Thirty-four variables including historical information, physical examination findings, and laboratory results were examined for association with survival. Variables associated with being discharged alive were entered into a multivariable logistic regression model. Accuracy of the model was validated prospectively on data from 163 foals.
Factors in the final model included age group, ability to stand, presence of a suckle reflex, WBC count, serum creatinine concentration, and anion gap. Sensitivity and specificity of the model to predict live discharge were 92% and 74%, respectively, in the retrospective population and 90% and 46%, respectively, in the prospective population. Accuracy of an equine clinician's initial prediction of the foal being discharged alive was 83%, and accuracy of the model's prediction was 81%. Combining the clinician's prediction of probability of live discharge with that of the model significantly increased (median increase, 12%) the accuracy of the prediction for foals that were discharged and nonsignificantly decreased (median decrease, 9%) the accuracy of the predication for nonsurvivors.
Combining the clinician's initial predication of the probability of a foal being discharged alive with that of the model appeared to provide a more precise early estimate of the probability of live discharge for hospitalized foals.
创建一个数学模型，以协助早期预测7日龄及以下住院新生驹出院的概率。
前瞻性研究。
1073匹新生驹。
回顾了910匹7日龄及以下住院新生驹的病历，这些新生驹的结局记录为死亡或存活出院。检查了包括病史信息、体格检查结果和实验室检查结果在内的34个变量与存活的相关性。将与存活出院相关的变量纳入多变量逻辑回归模型。该模型的准确性通过对163匹新生驹的数据进行前瞻性验证。
最终模型中的因素包括年龄组、站立能力、吸吮反射的存在、白细胞计数、血清肌酐浓度和阴离子间隙。在回顾性研究群体中，该模型预测存活出院的敏感性和特异性分别为92%和74%，在前瞻性研究群体中分别为90%和46%。马科临床医生对新生驹存活出院的初始预测准确性为83%，模型预测的准确性为81%。将临床医生对存活出院概率的预测与模型的预测相结合，显著提高了（中位数提高12%）已出院新生驹预测的准确性，对未存活者预测的准确性无显著降低（中位数降低9%）。
将临床医生对新生驹存活出院概率的初始预测与模型的预测相结合，似乎能为住院新生驹存活出院的概率提供更精确的早期估计。
