Weingarten S, Bolus R, Riedinger M S, Maldonado L, Stein S, Ellrodt A G
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Stroke. 1990 Sep;21(9):1280-2. doi: 10.1161/01.str.21.9.1280.
Although the development and use of severity-of-illness measures has gained widespread enthusiasm, uncertainty remains as to the optimal measure for stroke patients. The Health Care Financing Administration recently derived a severity-of-illness measure based on the APACHE II system to explain differences in Medicare mortality rates among hospitals treating stroke patients. We hypothesized that the Glasgow Coma Scale score provides prognostic information of accuracy comparable to that of the APACHE II score for stroke patients, yet is simpler and cheaper to abstract from the medical record. We therefore studied 246 patients hospitalized with stroke, including 49 oversampled mortalities. The Glasgow Coma Scale score was as accurate as the APACHE II score in predicting stroke mortality both before (r = -0.50 and r = 0.50, respectively) and after (r = -0.40 and r = 0.38, respectively) the oversampled mortalities were excluded. The APACHE II score required abstraction of 16 variables from the medical record compared with three for the Glasgow Coma Scale score and required more than three times the time to abstract from the medical record. Therefore, in the interest of parsimonious data collection, the Glasgow Coma Scale may be a preferable severity-of-illness measure for patients with stroke.
尽管疾病严重程度评估方法的开发和应用已引发广泛关注，但对于中风患者而言，最佳评估方法仍不明确。医疗保健财务管理局最近基于急性生理与慢性健康状况评分系统（APACHE II）得出了一种疾病严重程度评估方法，以解释治疗中风患者的各医院在医疗保险死亡率方面的差异。我们推测，格拉斯哥昏迷量表评分可为中风患者提供与APACHE II评分相当的准确预后信息，且从病历中提取该评分更为简便、成本更低。因此，我们对246例中风住院患者进行了研究，其中包括49例超量采样的死亡病例。在排除超量采样的死亡病例之前（相关系数分别为-0.50和-0.50）和之后（相关系数分别为-0.40和-0.38），格拉斯哥昏迷量表评分在预测中风死亡率方面与APACHE II评分同样准确。与格拉斯哥昏迷量表评分只需从病历中提取3个变量相比，APACHE II评分需要提取16个变量，且提取所需时间是格拉斯哥昏迷量表评分的3倍多。因此，为了简化数据收集，对于中风患者，格拉斯哥昏迷量表可能是更优的疾病严重程度评估方法。
