Sax F L, Charlson M E
Arch Intern Med. 1987 May;147(5):929-34.
To identify patients likely to be admitted to a critical care unit as well as those at high risk of deterioration, we studied all patients admitted to the medical service. Cardiac patients had a high likelihood of unit admission even if they were rated as not ill and stable, whereas ill and unstable noncardiac patients went to the floor. Stable cardiac or noncardiac patients who were not severely ill had very low deterioration and mortality, but unstable, severely ill patients with cardiac or noncardiac reasons for admission had high deterioration rates. If the goal is to admit patients at highest risk, the optimal strategy is to admit unstable, severely ill, and moribund patients in both the cardiac and noncardiac groups. By doing this, it is possible to decrease unit admission of patients likely to do well, increase the admission of patients likely to do poorly, while decreasing the number of patients admitted.
为了识别可能被收入重症监护病房的患者以及病情恶化风险高的患者，我们研究了所有入住内科病房的患者。心脏病患者即使被评定为病情不严重且稳定，也有很高的入住重症监护病房的可能性，而病情严重且不稳定的非心脏病患者则进入普通病房。病情稳定且不严重的心脏病或非心脏病患者病情恶化和死亡的可能性非常低，但因心脏病或非心脏病原因入院的不稳定、重症患者病情恶化率很高。如果目标是收治风险最高的患者，最佳策略是收治心脏病组和非心脏病组中不稳定、重症和濒死的患者。通过这样做，可以减少可能预后良好的患者入住重症监护病房的人数，增加可能预后不良的患者的入院人数，同时减少入院患者的数量。
