From the Indiana University School of Medicine, Indianapolis, Indiana (S.A.S., S.W.L., L.T.); University of California-Davis, Davis, California (G.H.U., J.A.C.); Cooper University Health Care, Camden, New Jersey (S.M.W., K.C.); George Washington University, Washington, DC (B.S., J.H.); John Peter Smith Health Network, Fort Worth, Texas (T.M.D., R.R.G.); Mayo Clinic-Rochester, Rochester, Minnesota (M.D.Z., M.R-Z.); Medical Center of the Rockies, Loveland, Colorado (J.T., T.C.); University of Western Ontario, London, Ontario (P.B.M., K.N.V.); University of Colorado Health, Aurora, Colorado (T.J.S., E.C.); University of California-San Diego, San Diego, California (L.K., R.C.); Yale School of Medicine, New Haven, Connecticut (K.M.S., D.G.); and Health Sciences Center, Jacksonville, Florida (A.L., M.C.).
J Trauma Acute Care Surg. 2019 Apr;86(4):601-608. doi: 10.1097/TA.0000000000002175.
Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs).
This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.
1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well.
This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.
Prognostic/Epidemiologic retrospective multicenter trial, level III.
在过去的 5 年中，美国创伤外科学会已经为急诊普通外科（EGS）疾病开发了分级量表。在之前使用憩室炎进行的验证研究中，这些分级量表可预测并发症和住院时间。由于 EGS 涵盖了多种疾病，因此本研究的目的是针对具有更高死亡率的不同疾病过程来验证分级量表概念。我们假设分级量表可预测皮肤和软组织感染（STI）的并发症、住院时间和死亡率。
这项多机构试验包括 12 个中心。收集的数据包括人口统计学变量、疾病特征以及死亡率、总体并发症和住院及 ICU 住院时间等结果。使用 STI 的 EGS 量表对每个感染进行分级，两位外科医生对每个病例进行分级以评估组内可靠性。
本研究纳入了 1170 例患者。组内可靠性为中度（kappa 系数为 0.472-0.642，一致性为 64%-76%）。与较低的 EGS 分级相比，较高的分级（IV 和 V）与更高的实验室风险指标坏死性筋膜炎评分相对应。IV 和 V 级 STI 患者发生所有并发症以及 ICU 和总体住院时间延长的可能性显著增加。在控制年龄、性别、合并症、精神状态和医院级别容量后，这些关联在逻辑回归中仍然显著。V 级疾病与死亡率显著相关。
这项验证工作表明，IV 和 V 级 STI 显著预测并发症、住院时间和死亡率。尽管预测能力不会随 STI 分级呈线性提高，但这与临床疾病过程一致，较低的分级代表蜂窝织炎和脓肿，而较高的分级则是侵袭性感染。第二项验证研究证实，EGS 分级量表在不同疾病过程中具有预测性且易于使用。
预后/流行病学回顾性多中心试验，III 级。
