Bundeswehr Institute of Radiobiology, Munich, Germany.
Helmut Schmidt University, Hamburg, Germany.
Health Phys. 2020 Jul;119(1):64-71. doi: 10.1097/HP.0000000000001247.
Treatment regimens for acute radiation syndrome have been improved over the past years. The application of appropriate therapy relies on rapid and high-throughput tests ideally conducted in the first 3 d after a radiation exposure event. We have examined the utility of blood cell counts (BCCs) 3 d post irradiation to predict clinical outcome for hematologic acute radiation syndrome (HARS). The BCCs and HARS severity information originated from data available in the System-for-Evaluation-and-Archiving-of-Radiation Accidents-based-on-Case-Histories (SEARCH). We found an almost complete discrimination of unexposed (HARS score H0) vs. irradiated individuals during model development and validation (negative predictive value > 94%) when using BCC data for all 3 d. We also found that BCC data increased the correct prediction of exposed individuals from day 1 to day 3. We developed spreadsheets to calculate the likelihood of correct diagnoses of the worried-well, requirement of hospitalization (HARS 2-4), or development of severe hematopoietic syndrome (HARS 3-4). In two table-top exercises, we found the spreadsheets were confusing and cumbersome, so we converted the spreadsheets into a smartphone application, named the H-module App, designed for ease of use, wider dissemination, and accommodation of co-morbidities in the HARS severity prediction algorithm.
在过去的几年中，急性辐射综合征的治疗方案已经得到了改善。适当治疗的应用依赖于快速和高通量的测试，理想情况下应在辐射暴露事件发生后的头 3 天内进行。我们已经检查了在辐射后第 3 天的血细胞计数 (BCC) 对预测血液学急性辐射综合征 (HARS)的临床结果的效用。BCC 和 HARS 严重程度信息源自基于病例历史的辐射事故评估和存档系统 (SEARCH)中可用的数据。在模型开发和验证期间，当使用所有 3 天的 BCC 数据时，我们发现几乎可以完全区分未暴露（HARS 评分 H0）和照射个体（阴性预测值>94%）。我们还发现，BCC 数据增加了从第 1 天到第 3 天暴露个体的正确预测。我们开发了电子表格来计算正确诊断疑似病例、住院需求（HARS 2-4）或发展严重造血综合征（HARS 3-4）的可能性。在两项桌面演练中，我们发现电子表格令人困惑和繁琐，因此我们将电子表格转换为智能手机应用程序，命名为 H 模块应用程序，旨在便于使用、更广泛的传播，并适应 HARS 严重程度预测算法中的合并症。
