Christensen C, Cottrell J J, Murakami J, Mackesy M E, Fetzer A S, Elstein A S
Department of Psychology, University of Hartford, West Hartford, CT 06117.
Methods Inf Med. 1993 Aug;32(4):302-8.
Physicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient's stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient's first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.
医生常常需要做出预后判断。在本研究中，探讨了医学重症监护病房（MICU）患者生存估计的准确性。在每位患者入住MICU期间，医生和护士会多次进行估计，并将其与APACHE II量表（一种广泛用于危重症患者的定量指标）的估计结果进行比较。进行ROC曲线和校准曲线分析以评估这些估计的准确性。结果显示，MICU工作人员对存活患者和死亡患者的区分相当准确，尽管存在持续低估生存率的趋势。此外，医生培训水平与预测准确性之间存在一定关系，但仅在患者入住MICU的最初24小时内存在这种关系。最后，医生的估计与APACHE II量表的估计没有显著差异。医生的预测往往校准得更好，而APACHE II量表在区分能力方面略胜一筹。
