一种新型生理急诊手术急性程度评分（PESAS）的推导与验证
Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS).
作者信息
Sangji Naveen F, Bohnen Jordan D, Ramly Elie P, Velmahos George C, Chang David C, Kaafarani Haytham M A
机构信息
Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA.
出版信息
World J Surg. 2017 Jul;41(7):1782-1789. doi: 10.1007/s00268-017-3915-9.
BACKGROUND
We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES).
METHODS
Using the 2011 ACS-NSQIP database, we identified all patients who underwent "emergent" surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database.
RESULTS
From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable.
CONCLUSION
PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
背景
我们提出了一种新颖且简化的生理紧急手术急性严重程度评分（PESAS），用于评估接受急诊手术（ES）患者就诊时的疾病严重程度。
方法
利用2011年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，我们识别出所有接受“急诊”手术的患者。设计了以下方法：（1）识别30天死亡率的独立预测因素，这些因素是急性严重程度的标志物；（2）根据每个预测因素的相对影响（即优势比）推导PESAS；（3）测量c统计量。使用2012年ACS-NSQIP数据库对PESAS进行验证。
结果
从24,702例急诊手术病例中得出了一个15分的评分。这包括10个组成部分，范围为0至15分。其c统计量为0.80。评分分别为0、8和15时，死亡率从1.7%逐渐升至40.6%再到100%。在验证阶段，PESAS的c统计量保持稳定。
结论
PESAS是一种新颖的评分系统，可评估急诊手术患者就诊时疾病的急性严重程度，且与术后死亡风险密切相关。PESAS可能对术前咨询和风险调整后的基准评估有用。
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