Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 630-522, South Korea.
Am J Emerg Med. 2012 Jun;30(5):749-53. doi: 10.1016/j.ajem.2011.05.022. Epub 2011 Jul 29.
The aim of this study was to assess the ability of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, and Trauma and Injury Severity Score (TRISS) method to predict group mortality for intensive care unit (ICU) trauma patients.
The medical records of 706 consecutive major trauma patients admitted to the ICU of Samsung Changwon Hospital from May 2006 to April 2010 were retrospectively examined. The SOFA and the APACHE II scores were calculated based on data from the first 24 hours of ICU admission, and the TRISS was calculated using initial laboratory data from the emergency department and operative data. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and TRISS equations. The ability to predict group mortality for the SOFA score, APACHE II score, and TRISS method was assessed by using 2-by-2 decision matrices and receiver operating characteristic curve analysis and calibration analysis.
In 2-by-2 decision matrices with a decision criterion of 0.5, the sensitivities, specificities, and accuracies were 74.1%, 97.1%, and 92.4%, respectively, for the SOFA score; 58.5%, 99.6%, and 91.1%, respectively, for the APACHE II scoring system; and 52.4%, 94.8%, and 86.0%, respectively, for the TRISS method. In the receiver operating characteristic curve analysis, the areas under the curve for the SOFA score, APACHE II scoring system, and TRISS method were 0.953, 0.950, and 0.922, respectively.
The results from the present study showed that the SOFA score was not different from APACHE II scoring system and TRISS in predicting the outcomes for ICU trauma patients. However, the method for calculating SOFA scores is easier and simpler than APACHE II and TRISS.
本研究旨在评估序贯器官衰竭评估（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分和创伤与损伤严重程度评分（TRISS）方法预测重症监护病房（ICU）创伤患者群体死亡率的能力。
回顾性分析 2006 年 5 月至 2010 年 4 月期间入住三星昌原医院 ICU 的 706 例连续重症创伤患者的病历资料。根据 ICU 入院后 24 小时内的数据计算 SOFA 和 APACHE Ⅱ评分，并根据急诊科的初始实验室数据和手术数据计算 TRISS。根据 SOFA 评分、APACHE Ⅱ评分和 TRISS 方程计算每位患者的死亡概率。使用 2×2 决策矩阵和受试者工作特征曲线分析和校准分析评估 SOFA 评分、APACHE Ⅱ评分和 TRISS 方法预测群体死亡率的能力。
在决策标准为 0.5 的 2×2 决策矩阵中，SOFA 评分的敏感性、特异性和准确性分别为 74.1%、97.1%和 92.4%；APACHE Ⅱ评分系统分别为 58.5%、99.6%和 91.1%；TRISS 方法分别为 52.4%、94.8%和 86.0%。在受试者工作特征曲线分析中，SOFA 评分、APACHE Ⅱ评分系统和 TRISS 方法的曲线下面积分别为 0.953、0.950 和 0.922。
本研究结果表明，SOFA 评分与 APACHE Ⅱ评分系统和 TRISS 法在预测 ICU 创伤患者结局方面无差异。然而，SOFA 评分的计算方法比 APACHE Ⅱ和 TRISS 更简单。
