Gompertz P, Pound P, Ebrahim S
Royal Free Hospital School of Medicine, Department of Public Health and Primary Care, London, UK.
J Neurol Neurosurg Psychiatry. 1994 Aug;57(8):932-5. doi: 10.1136/jnnp.57.8.932.
This study aimed to cross validate the Guy's prognostic score in a new sample of patients of all ages admitted to hospital with a stroke and to devise and test a simpler version (the G-score). 361 consecutive acute patients with stroke who had been admitted to the acute hospitals in two adjacent health districts in East London were recruited and followed up for six months after the stroke. The G-score was derived by simplifying the weights used in calculating the Guy's score. With the conventional threshold of 0 for the Guy's score and 3 (out of 7) for the G-score, the sensitivity of both scores for predicting a bad outcome (death or Barthel score < 13 out of 20 at six months) was 0.72 and specificity was 0.63. The likelihood ratio for the Guy's score was 1.97 and for the G-score 1.95. Both versions of the score performed better than conscious level alone at predicting the outcome (sensitivity 0.47, specificity 0.73, likelihood ratio 1.74). Similar data are presented for different thresholds and prior probabilities. In addition, the G-score permits direct estimation of 95% confidence intervals for the probability of a bad outcome for five grades of stroke severity. Outcome prediction with multivariate techniques has the potential to improve and inform clinical decision making. The G-score should be used to define stroke severity for individual patients and for case mix adjustment.
本研究旨在对入住医院的各年龄段中风患者新样本进行盖伊预后评分的交叉验证，并设计和测试一个更简单的版本（G评分）。招募了361名连续入住东伦敦两个相邻健康区急症医院的急性中风患者，并在中风后随访6个月。G评分是通过简化计算盖伊评分时使用的权重得出的。对于盖伊评分，传统阈值为0；对于G评分，传统阈值为3（满分7分），两种评分预测不良结局（死亡或6个月时巴氏指数评分低于20分中的13分）的敏感性均为0.72，特异性均为0.63。盖伊评分的似然比为1.97，G评分的似然比为1.95。在预测结局方面，两种评分版本均比单独使用意识水平表现更好（敏感性0.47，特异性0.73，似然比1.74）。还给出了不同阈值和先验概率下的类似数据。此外，G评分允许直接估计五个中风严重程度等级不良结局概率的95%置信区间。采用多变量技术进行结局预测有可能改善并为临床决策提供依据。G评分应用于为个体患者定义中风严重程度以及进行病例组合调整。
