Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, AP 500082, India.
Anesth Analg. 2010 Jan 1;110(1):134-40. doi: 10.1213/ANE.0b013e3181c293a9. Epub 2009 Nov 21.
Numerous studies have developed a "severity score" or "risk index" for mechanical ventilation and mortality, but there are few to predict outcomes for cervical spine injury (CSI) patients. Our objective in this study was to develop a simple bedside additive predictive score for requirement for ventilation and early in-hospital mortality for patients with CSI.
Multivariate logistic regression analysis of the data obtained from 101 patients (development set) after surgical stabilization of traumatic CSI was performed to identify independent predictors of the need for mechanical ventilation and of early in-hospital mortality. Predictors of respiratory insufficiency and mortality (PRIM) scores were developed separately for ventilation and mortality by using the coefficients of the logistic regression model. The model was validated using the receiver operating characteristics curve to test its discriminatory ability and by comparing the predicted and observed outcomes. Validation was performed on an independent data set of 87 consecutive patients (validation set) with traumatic acute CSI.
Mechanical ventilation was required in 16.8% of the patients, and the in-hospital mortality rate was 17.8% in the development set. Independent risk factors for mechanical ventilation were severe injury (American Spinal Injury Association Impairment Scale Grades A and B), breath-holding time, pulmonary infection, hemodynamic instability, and progressive neurologic deterioration. Scores of 15, 20, 25, 25, and 15 were assigned to these variables, respectively. Independent predictors of death were severe injury (American Spinal Injury Association Impairment Scale Grades A and B), hemodynamic instability, progressive neurologic deterioration, and mechanical ventilation. The scores assigned for each of the variables were 20, 20, 40, and 20, respectively. The PRIM scores for mechanical ventilation and mortality had excellent discrimination (area under receiver operating characteristics curve >0.75). There was good correlation between predicted and observed outcomes in the development set and the validation set.
PRIM scores enable accurate prediction of individual patient risk of need for mechanical ventilation and in-hospital mortality in association with acute CSI.
许多研究已经为机械通气和死亡率开发了“严重程度评分”或“风险指数”，但很少有研究能够预测颈椎损伤（CSI）患者的预后。我们的研究目的是为 CSI 患者开发一种简单的床边附加预测评分，以预测通气需求和早期院内死亡率。
对 101 例创伤性 CSI 手术后接受手术稳定治疗的患者的数据进行多变量逻辑回归分析，以确定需要机械通气和早期院内死亡率的独立预测因素。通过使用逻辑回归模型的系数，分别为通气和死亡率开发呼吸功能不全和死亡率（PRIM）评分。使用受试者工作特征曲线测试模型的判别能力，并通过比较预测和观察结果来验证模型。使用 87 例连续创伤性急性 CSI 患者的独立数据集（验证集）进行验证。
患者中有 16.8%需要机械通气，发展组的院内死亡率为 17.8%。机械通气的独立危险因素为严重损伤（美国脊髓损伤协会损伤分级 A 和 B）、屏气时间、肺部感染、血流动力学不稳定和进行性神经功能恶化。分别为这些变量分配 15、20、25、25 和 15 分。死亡的独立预测因素为严重损伤（美国脊髓损伤协会损伤分级 A 和 B）、血流动力学不稳定、进行性神经功能恶化和机械通气。为每个变量分配的分数分别为 20、20、40 和 20。机械通气和死亡率的 PRIM 评分具有良好的区分能力（受试者工作特征曲线下面积>0.75）。在发展组和验证组中，预测结果与观察结果之间存在良好的相关性。
PRIM 评分可准确预测急性 CSI 患者机械通气和院内死亡率的个体患者风险。
