Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
Centre South West Jutland, Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, Denmark.
QJM. 2018 Oct 1;111(10):721-725. doi: 10.1093/qjmed/hcy174.
We believe errors in the risk assessment of acutely ill patients occur because only vital signs without concurrent functional capacity are considered. We, therefore, developed the PARIS risk score based on blood pressure, age, respiratory rate, loss of independence and oxygen saturation.
Validation of the PARIS score in four independent cohorts from three countries.
Retrospective cohort study of acutely ill patients admitted to hospitals in Denmark, Ireland and Uganda. Vital signs and functional capacity (registered as ability to stand or walk or get into bed unaided) was recorded upon arrival. Patients were followed up for 7 days (Denmark and Ireland) or until discharge (Uganda) and mortality recorded. The discriminatory power (ability to identify patients at increased risk) was determined using area under the receiver operating characteristics curve (AUROC) and calibration (precision) using Hosmer-Lemeshow goodness of fit test.
Out of 14 447 patients, 327 (2.3%) died within 7 days: median age was 59 (39-75) years and 7458 (51.8%) were female. Seven-day mortality increased from 0.3% with a score of 0-26.7% with a score of 5. The score's AUROC as 0.833 [95% confidence interval (95% CI) 0.811-0.856], 0.817 (95% CI 0.792-0.842) and 0.894 (95% CI 0.813-0.974) for all patients, medical patients and surgical patients, respectively. However, except for surgical patients, calibration of the score was poor.
The PARIS score can identify both high and low risk acutely admitted medical and surgical patients, but calibration was poor for medical patients.
我们认为，对急性病患者的风险评估会出现错误，是因为仅考虑生命体征，而未同时考虑其功能状态。因此，我们基于血压、年龄、呼吸频率、独立性丧失和血氧饱和度制定了 PARIS 风险评分。
在来自三个国家的四个独立队列中验证 PARIS 评分。
对丹麦、爱尔兰和乌干达的医院收治的急性病患者进行回顾性队列研究。入院时记录生命体征和功能状态（记录能否独立站立或行走，或能否自行上床）。对患者进行为期 7 天（丹麦和爱尔兰）或直至出院（乌干达）的随访，并记录死亡率。使用接受者操作特征曲线下面积（AUROC）评估区分能力（识别高风险患者的能力），并使用 Hosmer-Lemeshow 拟合优度检验评估校准（精度）。
在 14447 例患者中，327 例（2.3%）在 7 天内死亡：中位年龄为 59 岁（39-75 岁），7458 例（51.8%）为女性。评分 0-26 分的患者 7 天死亡率为 0.3%，评分 5 分的患者 7 天死亡率为 26.7%。该评分在所有患者、内科患者和外科患者中的 AUROC 分别为 0.833 [95%置信区间（95%CI）0.811-0.856]、0.817（95%CI 0.792-0.842）和 0.894（95%CI 0.813-0.974）。但除外科患者外，该评分的校准效果均较差。
PARIS 评分可识别内科和外科高风险和低风险急性入院患者，但内科患者的评分校准效果较差。
