Knaus W A, Wagner D P, Lynn J
Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037.
Science. 1991 Oct 18;254(5030):389-94. doi: 10.1126/science.1925596.
Modern life-sustaining therapy often succeeds in postponing death but may be ineffective at restoring health. Decisions that influence the time and circumstances of an individual's death are now common and require an accurate and comprehensive characterization of likely outcome. Evaluation of alternative outcomes requires acknowledgement that most patients find some outcomes to be worse than death. Improved understanding of major predictors of patient outcome, combined with rapidly expanding technical abilities to collect and manipulate large amounts of detailed clinical data, have created a new intellectual and technical basis for estimating outcomes from intensive medical care. Such objective probability estimates, such as the system described here, can reduce uncertainty about difficult clinical decisions and can be used by physicians, patients, and society to reorient health care toward more scientifically and ethically defensible approaches.
现代维持生命的疗法常常成功地推迟了死亡，但在恢复健康方面可能无效。如今，影响个人死亡时间和情况的决策很常见，这就需要对可能的结果进行准确而全面的描述。评估不同的结果需要认识到，大多数患者认为有些结果比死亡更糟糕。对患者预后主要预测因素的更好理解，再加上收集和处理大量详细临床数据的技术能力迅速扩展，为估计重症医疗的结果创造了新的知识和技术基础。像这里描述的系统这样的客观概率估计，可以减少艰难临床决策的不确定性，并且可以被医生、患者和社会用于将医疗保健重新导向更具科学和伦理依据的方法。
