Murray L S, Teasdale G M, Murray G D, Jennett B, Miller J D, Pickard J D, Shaw M D, Achilles J, Bailey S, Jones P
Department of Neurosurgery, University of Glasgow, Southern General Hospital, UK.
Lancet. 1993 Jun 12;341(8859):1487-91. doi: 10.1016/0140-6736(93)90631-p.
A patient's prognosis is a key factor for the clinicians involved in management. We set out to determine if provision of computer-based predictions of outcome after severe head injury resulted in measurable changes in patient management. In particular, we wondered whether introduction of the predictive system would alter the relation between severity of injury and "intensity" of management. 1025 patients admitted to four British neurosurgical units between 1986 and 1989 following a severe head injury, and who were either in coma for 6 h or had an operation for acute intracranial haematoma, were studied. Specified aspects of intensive management were recorded and all patients were followed up after six months. The study had three phases: a baseline period of at least one year before the introduction of computer-based outcome prediction, one year when predictions were provided at specified times, and a final six months when prediction was withdrawn. While predictions were being provided, there was an increase in the use of specified aspects of intensive care in patients predicted to have a good outcome, but a 39% reduction in the use of these same aspects of intensive care in patients predicted to have the worst outcome. There was no evidence that the provision of predictions affected overall outcome, length of stay, or the recording of explicit decisions to limit treatment. We have demonstrated that the introduction of a routine prediction service can alter patient management.
患者的预后是参与治疗的临床医生的关键考量因素。我们着手研究，提供基于计算机的重度颅脑损伤后预后预测是否会导致患者治疗发生可衡量的变化。具体而言，我们想知道引入该预测系统是否会改变损伤严重程度与治疗“强度”之间的关系。我们对1986年至1989年间因重度颅脑损伤入住英国四个神经外科病房的1025名患者进行了研究，这些患者要么昏迷6小时，要么因急性颅内血肿接受了手术。记录了强化治疗的特定方面，并在六个月后对所有患者进行了随访。该研究分为三个阶段：在引入基于计算机的预后预测前至少一年的基线期、在特定时间提供预测的一年以及停止预测的最后六个月。在提供预测期间，预计预后良好的患者对强化治疗特定方面的使用有所增加，但预计预后最差的患者对这些相同强化治疗方面的使用减少了39%。没有证据表明提供预测会影响总体预后、住院时间或限制治疗的明确决定的记录。我们已经证明，引入常规预测服务可以改变患者治疗。
