Nik Amir, Sheikh Andalibi Mohammad Sobhan, Ehsaei Mohammad Reza, Zarifian Ahmadreza, Ghayoor Karimiani Ehsan, Bahadoorkhan Gholamreza
Student Research Committee, School of Medicine, Mashhad University of medical sciences, Mashhad, Iran.
Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Bull Emerg Trauma. 2018 Apr;6(2):141-145. doi: 10.29252/beat-060208.
To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU.
This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II.
Positive predictive value (PPV) at the cut-off points was higher in APACHE II (80.6%) compared with GCS (69.2%). However, negative predictive value (NPV) of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic (ROC) curve for sensitivity and specificity of GCS and APACHE II showed no significant difference (0.81±0.04 vs. 0.83±0.04; =0.278 respectively).
Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency.
比较格拉斯哥昏迷量表（GCS）评分与急性生理与慢性健康状况评分系统II（APACHE II）对入住重症监护病房（ICU）的多发伤患者的疗效及功能预后评估。
本横断面研究纳入了2015年9月至2016年12月期间入住马什哈德市沙希德·卡米亚布医院ICU的125例伴有全身创伤的创伤性脑损伤患者。入院当天，收集每位患者的数据以计算GCS和APACHE II评分。比较GCS和APACHE II之间的敏感性、特异性及正确预后预测情况。
在截断点处，APACHE II的阳性预测值（PPV）（80.6%）高于GCS（69.2%）。然而，GCS的阴性预测值（NPV）相比APACHE II略高。此外，GCS和APACHE II的受试者工作特征（ROC）曲线下面积在敏感性和特异性方面无显著差异（分别为0.81±0.04和0.83±0.04；P = 0.278）。
我们的研究表明，GCS和APACHE II评分在预测颅脑损伤患者死亡率方面无显著差异。两种评分系统均显示出可接受的PPV，而APACHE II表现更佳。然而，鉴于GCS在初始评估中具有更高的时间和成本效益，建议优先使用GCS而非APACHE II。
