Hartley C, Cozens A, Mendelow A D, Stevenson J C
University Department of Surgery (Neurosurgery), Regional Neuroscience Centre, Newcastle General Hospital, UK.
Br J Neurosurg. 1995 Apr;9(2):179-87. doi: 10.1080/02688699550041520.
In order to compare the predictive value of the Apache II, the Glasgow Coma Scale and Revised Trauma Scoring systems in relation to outcome in a neurosurgical department high dependency unit (HDU), all 109 patients entering the unit under the care of one consultant were studied. All patients in the HDU were self-ventilating, so that motor responses were not suppressed by muscle relaxants or sedation. Initial Minimum and Maximum Glasgow Coma Scale Scores, Revised Trauma Score, Apache II and the Apache minus neurological weighting (Apache-NW) scores, were compared as predictors of outcome (as assessed by the Glasgow Outcome Score at 6 months). Twenty-eight patients had a bad outcome, i.e. Glasgow Outcome Scores 1-3, and 72 individuals a good outcome, i.e. scores 4 or 5. Statistical analysis was by the Spearman Ranked Correlation Test, and comparison of Receiver Operational Characteristics Curves. Data were complete on 100 patients (91.7%) and show the Maximum Glasgow Coma Score, followed by the Apache II score, as the best predictors of outcome analysed. This was also true if all patients except those with head injury were analysed as a group. All scoring systems were significantly better predictors of outcome in the head injured patient. For this group, Apache II had an outcome predictive value of 97% compared with 93% for initial and 95% for minimum GCS. Removing the neurological weighting from Apache II weakened its predictive ability in all patients, emphasizing that it is the neurological status of the patient which best predicts overall functional outcome. Apache II data are also much more time-consuming to collect than GCS data.(ABSTRACT TRUNCATED AT 250 WORDS)
为了比较急性生理与慢性健康状况评分系统Ⅱ（Apache II）、格拉斯哥昏迷量表（Glasgow Coma Scale）和修正创伤评分系统在神经外科高依赖病房（HDU）中对预后的预测价值，对在一位会诊医生照料下进入该病房的109例患者进行了研究。HDU中的所有患者均自主呼吸，因此运动反应未被肌肉松弛剂或镇静剂抑制。比较初始格拉斯哥昏迷量表最低和最高评分、修正创伤评分、Apache II评分以及去除神经学权重后的Apache评分（Apache-NW）作为预后预测指标（通过6个月时的格拉斯哥预后评分评估）。28例患者预后不良，即格拉斯哥预后评分1 - 3分，72例患者预后良好，即评分4或5分。采用Spearman等级相关检验和受试者操作特征曲线比较进行统计分析。100例患者（91.7%）数据完整，结果显示格拉斯哥昏迷量表最高评分，其次是Apache II评分，是所分析的最佳预后预测指标。若将除头部受伤患者外的所有患者作为一组分析，情况也是如此。所有评分系统对头部受伤患者的预后预测能力明显更好。对于该组患者，Apache II的预后预测价值为97%，而初始格拉斯哥昏迷量表为93%，最低格拉斯哥昏迷量表为95%。从Apache II中去除神经学权重会削弱其在所有患者中的预测能力，强调患者的神经学状态最能预测总体功能预后。收集Apache II数据也比收集格拉斯哥昏迷量表数据耗时得多。（摘要截选于250字）
