重症监护协会在英国和爱尔兰开展的急性生理学及慢性健康状况评分系统（APACHE II）研究——I：成人入住综合重症监护病房病例组合的差异及其对预后的影响
Intensive Care Society's APACHE II study in Britain and Ireland--I: Variations in case mix of adult admissions to general intensive care units and impact on outcome.
作者信息
Rowan K M, Kerr J H, Major E, McPherson K, Short A, Vessey M P
机构信息
Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary.
出版信息
BMJ. 1993 Oct 16;307(6910):972-7. doi: 10.1136/bmj.307.6910.972.
Abstract
OBJECTIVES
To describe the extent of variation in the case mix of adult admissions to general intensive care units in Britain and Ireland and investigate the impact of such variation on outcome.
DESIGN
Prospective, cohort study of consecutive admissions to intensive care units.
SETTING
26 general intensive care units in Britain and Ireland.
SUBJECTS
9099 admissions to the intensive care units studied.
MAIN OUTCOME MEASURE
Death or survival at discharge before and after adjustment of case mix (age, history of chronic conditions, surgical status, diagnosis, and severity of illness) according to the APACHE II method.
RESULTS
Important differences in case mix were found, with large variations between the units. Hospital mortality was significantly associated with most of the case mix factors investigated.
CONCLUSIONS
Comparing crude death rates in hospital between intensive care units may be misleading indicators of performance. The collection of data on case mix needs to be standardised and differences in case mix adjusted for when comparing outcome between different intensive care units.
摘要
目的
描述英国和爱尔兰成人入住综合重症监护病房的病例组合差异程度，并调查这种差异对预后的影响。
设计
对重症监护病房连续入院患者进行的前瞻性队列研究。
地点
英国和爱尔兰的26个综合重症监护病房。
研究对象
所研究的重症监护病房的9099例入院患者。
主要观察指标
根据APACHE II方法，在调整病例组合（年龄、慢性病病史、手术状态、诊断和疾病严重程度）前后的出院时死亡或存活情况。
结果
发现病例组合存在重要差异，各病房之间差异很大。医院死亡率与所调查的大多数病例组合因素显著相关。
结论
比较重症监护病房之间医院的粗死亡率可能会误导绩效指标。在比较不同重症监护病房的预后时，需要对病例组合数据的收集进行标准化，并对病例组合差异进行调整。
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