Ron A, Aronne L J, Kalb P E, Santini D, Charlson M E
Department of Medicine, Cornell University, New York, NY.
Arch Intern Med. 1989 Feb;149(2):338-41.
The majority of patients are admitted to critical care units for observation and to facilitate intervention if deterioration occurs or complications develop. We attempted to determine if a reduction in mortality in a subgroup of these patients admitted directly to the critical care units could be identified. A new method using the scientific principles of a randomized trial applied to the case-control design was employed. All 1905 patients admitted to the medical service over a three-month period were prospectively evaluated for illness severity and stability. Patients who would not have been eligible for a randomized clinical trial were excluded. Based on the prospective evaluations, four prognostically distinct subgroups of patients were formed. An odds ratio for each of the prognostic groups was calculated, a ratio of greater than 1 indicating a protective effect of direct critical care admission. Only one subgroup of patients, the unstable moderately ill, had an odds ratio greater than 1 (13.3). These results, in association with the results of our previous study, suggest that at the time of admission to the hospital, direct admission to the critical care unit reduced mortality among the unstable moderately ill subgroup of patients.
大多数患者被收入重症监护病房进行观察，并在病情恶化或出现并发症时便于进行干预。我们试图确定能否找出直接收入重症监护病房的这类患者亚组中死亡率降低的情况。采用了一种将随机试验的科学原理应用于病例对照设计的新方法。对三个月内入住内科的所有1905例患者进行前瞻性评估，以确定疾病严重程度和稳定性。排除不符合随机临床试验条件的患者。根据前瞻性评估，形成了四个预后不同的患者亚组。计算每个预后组的比值比，比值比大于1表明直接入住重症监护病房具有保护作用。只有一个患者亚组，即不稳定的中度疾病患者，其比值比大于1（13.3）。这些结果与我们之前的研究结果表明，在入院时，直接入住重症监护病房可降低不稳定的中度疾病患者亚组的死亡率。
