计算机化临床决策支持可改善腹腔内外科脓毒症患者的死亡率。
Computerized clinical decision support improves mortality in intra abdominal surgical sepsis.
机构信息
Weill Cornell Medical College, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Houston, TX, USA.
出版信息
Am J Surg. 2010 Dec;200(6):839-43; discussion 843-4. doi: 10.1016/j.amjsurg.2010.07.036.
BACKGROUND
The management of surgical sepsis is challenging because of the complexity of interventions. The authors therefore created a computerized clinical decision support program to facilitate this process, with the goal of improving abdominal sepsis mortality.
METHODS
The authors evaluated a prospective database for all patients requiring surgery for abdominal sepsis. Patient demographics, Acute Physiology and Chronic Health Evaluation II score, sepsis source, and hospital mortality data were obtained. Observed mortality was compared with predicted mortality using Fisher's exact test.
RESULTS
Eighty-seven patients met the inclusion criteria. The average age was 59 ± 17.0 years, and 39% were men. The most common source of infection was the colon (45%). The average Acute Physiology and Chronic Health Evaluation II score was 27.6 ± 9.72. The overall actual mortality rate for the cohort was 24% compared with a predicted Acute Physiology and Chronic Health Evaluation II mortality of 62.5% (P < .0001).
CONCLUSION
The use of computerized clinical decision support results in significantly improved survival in patients with intra-abdominal surgical sepsis.
背景
由于干预措施的复杂性，外科脓毒症的治疗具有挑战性。因此，作者创建了一个计算机化的临床决策支持程序来促进这一过程，目标是降低腹腔脓毒症的死亡率。
方法
作者评估了所有需要手术治疗腹腔脓毒症的患者的前瞻性数据库。获得了患者人口统计学、急性生理学和慢性健康评估 II 评分、脓毒症来源和医院死亡率数据。使用 Fisher 精确检验比较观察死亡率与预测死亡率。
结果
87 名患者符合纳入标准。平均年龄为 59 ± 17.0 岁，39%为男性。最常见的感染源是结肠（45%）。平均急性生理学和慢性健康评估 II 评分为 27.6 ± 9.72。该队列的总体实际死亡率为 24%，而预测的急性生理学和慢性健康评估 II 死亡率为 62.5%（P <.0001）。
结论
使用计算机化临床决策支持可显著提高腹腔内外科脓毒症患者的生存率。
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