Goldberg J L, Goldberg J, Levy P S, Finnegan R, Petrucelli E
J Trauma. 1984 May;24(5):420-7.
This study examines the validity of the Revised Estimated Survival Probability (RESP) index in a set of trauma patients admitted to three hospitals. For each patient four different severity indices were computed: 1) RESP derived from in-hospital assigned International Classification of Disease (ICD) codes; 2) RESP based on written face sheet discharge diagnoses; 3) RESP based on a full review of the medical record; and 4) Injury Severity Score (ISS) based on full review of the medical record. These four severity indices were then correlated with six measures of outcome or construct validity, including mortality, duration of hospitalization, intubation or tracheostomy performed, ambulance transport to hospital, admission to the intensive care unit, and ventilatory assistance received. The results indicate that for every validity measure examined, the ISS index was superior to the RESP index, regardless of the abstraction procedure. However, the RESP index was independently associated with mortality, length of hospitalization, and ventilatory assistance even after adjusting for the ISS. In addition, the performance of the RESP index improved dramatically as the quality of information improved. Last, strong evidence is presented which questions the utility of calculating any type of severity index using data from computerized discharge abstracts without careful quality control measures.
本研究考察了修订后的估计生存概率（RESP）指数在三家医院收治的一组创伤患者中的有效性。为每位患者计算了四种不同的严重程度指数：1）根据住院时指定的国际疾病分类（ICD）编码得出的RESP；2）基于书面出院小结诊断的RESP；3）基于对病历全面审查的RESP；4）基于对病历全面审查的损伤严重程度评分（ISS）。然后将这四种严重程度指数与六种结局或结构效度指标进行关联，包括死亡率、住院时间、是否进行插管或气管切开、救护车送往医院的情况、入住重症监护病房以及接受通气辅助的情况。结果表明，对于所考察的每一项效度指标，无论采用何种抽象程序，ISS指数均优于RESP指数。然而，即使在对ISS进行调整之后，RESP指数仍与死亡率、住院时间和通气辅助独立相关。此外，随着信息质量的提高，RESP指数的表现有显著改善。最后，有强有力的证据对在没有仔细质量控制措施的情况下使用计算机化出院摘要数据计算任何类型严重程度指数的效用提出了质疑。
