Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Department of Oral and Maxillofacial Surgery, Shizuoka General Hospital, Shizuoka, Japan.
Medicine (Baltimore). 2021 Jul 30;100(30):e26712. doi: 10.1097/MD.0000000000026712.
In oral cancer surgery, the decision to perform a tracheotomy is often determined by the surgeon. In this study, we investigated the competency of clinical scoring systems in identifying patients who require tracheotomy and examined the degree of agreement between the surgeon's decision and the indications of various scoring systems. We identified 110 patients who were surgically treated for oral cancer. Of these, 67 patients (44 men and 23 women) who underwent resection and reconstruction were retrospectively analyzed. To derive the score, we evaluated the endpoint of the airway management score using clinical records and images. We divided the patients into two groups based on the Cameron and Gupta scores (tracheotomy and no-tracheotomy groups) and evaluated the degree of agreement with the surgeon's decision by calculating the κ coefficient. The κ coefficients of the Gupta and Cameron scores were 0.61 (95% confidence interval [CI]: 0.40-0.82) and 0.60 (95% CI: 0.38-0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Cameron and Gupta scores agreed fairly with the surgeon's decision. In this study, the Cameron and Gupta scores fairly agreed with the decision of experienced surgeons and were confirmed as acceptable guides for making clinical judgments.
在口腔癌手术中，是否进行气管切开术的决策通常由外科医生决定。在这项研究中，我们调查了临床评分系统在识别需要气管切开术的患者方面的能力，并研究了外科医生的决策与各种评分系统的指征之间的一致性程度。我们确定了 110 名接受口腔癌手术治疗的患者。其中，对 67 名（44 名男性和 23 名女性）接受切除术和重建术的患者进行了回顾性分析。为了得出评分，我们使用临床记录和图像评估了气道管理评分的终点。我们根据 Cameron 和 Gupta 评分（气管切开术组和非气管切开术组）将患者分为两组，并通过计算κ系数评估与外科医生决策的一致性程度。Gupta 和 Cameron 评分的κ系数分别为 0.61（95%置信区间：0.40-0.82）和 0.60（95%置信区间：0.38-0.82）。κ系数的临床评估表明，Cameron 和 Gupta 评分与外科医生的决策相当一致。在这项研究中，Cameron 和 Gupta 评分与经验丰富的外科医生的决策相当一致，被确认为做出临床判断的可接受指南。
