Franklin C, Rackow E C, Mamdani B, Burke G, Weil M H
Department of Medicine, Cook County Hospital, Chicago, Ill.
Arch Intern Med. 1990 Jul;150(7):1455-9.
As an initial step toward improving admission criteria to the medical intensive care unit (MICU), we examined Acute Physiologic and Chronic Health Evaluation scores and the diagnosis-adjusted mortality rates of 2419 medical patients, including those who received MICU consultation over a 6-month period. There was considerable overlap in the physiologic scores and the predicted mortality rates between those patients who were admitted to the MICU and those who were not. There was no discrete score or mortality rate at which triage to the MICU would have included most MICU patients but excluded most patients who survived without admission to the MICU. While uniform MICU admission criteria would be desirable, current scoring systems may not have the desired sensitivity or specificity to establish such criteria. Using a receiver operating characteristic curve, we demonstrated that diagnosis-adjusted mortality rates could predict as well as Acute Physiologic and Chronic Health Evaluation scores which patients would receive MICU admission and intervention. This suggests that, for different diagnoses, specific clinical variables and laboratory tests may have different predictive importance for MICU admission. Prospective models of clinical variables using receiver operating characteristic curves in various medical diseases may improve triage procedures.
作为改进医学重症监护病房（MICU）收治标准的第一步，我们检查了2419例内科患者的急性生理与慢性健康状况评估（APACHE）评分及诊断校正死亡率，其中包括在6个月期间接受MICU会诊的患者。入住MICU的患者与未入住MICU的患者在生理评分和预测死亡率方面存在相当大的重叠。不存在一个离散的评分或死亡率，基于此对MICU进行分诊就能纳入大多数MICU患者，同时排除大多数未入住MICU却存活的患者。虽然理想的情况是采用统一的MICU收治标准，但目前的评分系统可能没有建立此类标准所需的敏感性或特异性。通过绘制受试者工作特征曲线，我们证明诊断校正死亡率与急性生理与慢性健康状况评估评分一样，能够预测哪些患者会接受MICU收治及干预。这表明，对于不同的诊断，特定的临床变量和实验室检查对MICU收治可能具有不同的预测重要性。利用受试者工作特征曲线对各种内科疾病的临床变量建立前瞻性模型，可能会改善分诊程序。
