Hashmi M, Asghar A, Shamim F, Khan F H
Department of Anaesthesiology, Aga Khan University, Karachi 74800, Pakistan.
Saudi J Anaesth. 2016 Jan-Mar;10(1):45-9. doi: 10.4103/1658-354X.169474.
To assess the predictive performance of Acute Physiologic and Chronic Health Evaluation II (APACHE II) software available on the hospital intranet and analyze interrater reliability of calculating the APACHE II score by the gold standard manual method or automatically using the software.
An expert scorer not involved in the data collection had calculated APACHE II score of 213 patients admitted to surgical Intensive Care Unit using the gold standard manual method for a previous study performed in the department. The same data were entered into the computer software available on the hospital intranet (http://intranet/apacheii) to recalculate the APACHE II score automatically along with the predicted mortality. Receiver operating characteristic curve (ROC), Hosmer-Lemeshow goodness-of-fit statistical test and Pearson's correlation coefficient was computed.
The 213 patients had an average APACHE II score of 17.20 ± 8.24, the overall mortality rate was 32.8% and standardized mortality ratio was 1.00. The area under the ROC curve of 0.827 was significantly >0.5 (P < 0.01) and had confidence interval of 0.77-0.88. The goodness-of-fit test showed a good calibration (H = 5.46, P = 0.71). Interrater reliability using Pearson's product moment correlations demonstrated a strong positive relationship between the computer and the manual expert scorer (r = 0.98, P = 0.0005).
APACHE II software available on the hospital's intranet has satisfactory calibration and discrimination and interrater reliability is good when compared with the gold standard manual method.
评估医院内部网提供的急性生理与慢性健康状况评估系统II（APACHE II）软件的预测性能，并分析采用金标准手工方法或使用该软件自动计算APACHE II评分时的评分者间信度。
在之前该科室进行的一项研究中，一名未参与数据收集的专家评分者采用金标准手工方法计算了213例入住外科重症监护病房患者的APACHE II评分。将相同数据输入医院内部网（http://intranet/apacheii）上的计算机软件，以自动重新计算APACHE II评分及预测死亡率。计算受试者工作特征曲线（ROC）、Hosmer-Lemeshow拟合优度统计检验及Pearson相关系数。
213例患者的APACHE II评分平均为17.20±8.24，总死亡率为32.8%，标准化死亡率为1.00。ROC曲线下面积为0.827，显著大于0.5（P<0.01），置信区间为0.77 - 0.88。拟合优度检验显示校准良好（H = 5.46，P = 0.71）。使用Pearson积矩相关性的评分者间信度表明，计算机与手工专家评分者之间存在强正相关关系（r = 0.98，P = 0.0005）。
医院内部网提供的APACHE II软件具有令人满意的校准和区分能力，与金标准手工方法相比，评分者间信度良好。
