Alvarez M, Nava J M, Rué M, Quintana S
Intensive Care Unit, Hospital Mútua de Terrassa, Barcelona, Spain.
Crit Care Med. 1998 Jan;26(1):142-8. doi: 10.1097/00003246-199801000-00030.
To assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Mortality Probability Models [MPM] II) for head trauma patients and to compare these systems with the Glasgow Coma Score, in order to obtain a good estimate of severity of illness and probability of hospital mortality.
Inception cohort.
Adult medical and surgical intensive care units in 12 European and North American countries.
Patients (n = 401) who were diagnosed with head trauma (with/without multiple trauma), leading to intensive care unit admission, and who were not brain dead at the time of arrival.
Statistical analysis to assess the performance of general severity systems.
Vital status at the time of hospital discharge was the outcome measure. Performance of the severity systems (SAPS II, MPM II0 [MPM at admission], MPM II24 [MPM at 24 hrs], and APACHE II) was assessed by evaluating calibration and discrimination. Logistic regression was used to convert the Glasgow Coma Score into a probability of death. The MPM II system (either MPM II0 or MPM 1124) provided an adequate estimation of the mortality experience in patients with head trauma. SAPS II and APACHE II systems did not calibrate well, although they showed high discrimination (area under the receiver operating characteristic curve 0.95 for SAPS II, 0.94 for APACHE II, and 0.90 for MPM II0 and MPM II24). The logistic regression model containing the Glasgow Coma Score as an independent variable and developed in this group of patients was not as well calibrated as MPM II. The discrimination of this model was very high, in the range observed for the APACHE II, SAPS II, and MPM II systems.
The MPM II system performs better than APACHE II, SAPS II, and Glasgow Coma Score for head trauma patients. If our results are supported by other studies, MPM II would be an appropriate tool to assess severity of illness in head trauma patients, with applications to clinical practice and clinical research.
评估通用严重程度评估系统（急性生理与慢性健康状况评估[APACHE]II、简化急性生理学评分[SAPS]II和死亡概率模型[MPM]II）在颅脑创伤患者中的表现，并将这些系统与格拉斯哥昏迷评分进行比较，以便对疾病严重程度和医院死亡概率做出良好估计。
起始队列研究。
12个欧洲和北美国家的成人内科和外科重症监护病房。
401例被诊断为颅脑创伤（伴/不伴多发伤）并入住重症监护病房、入院时未脑死亡的患者。
进行统计分析以评估通用严重程度评估系统的表现。
以出院时的生命状态作为结局指标。通过评估校准度和区分度来评估严重程度评估系统（SAPS II、MPM II0[入院时的MPM]、MPM II24[24小时时的MPM]和APACHE II）的表现。采用逻辑回归将格拉斯哥昏迷评分转换为死亡概率。MPM II系统（MPM II0或MPM II24）对头外伤患者的死亡情况提供了充分的估计。SAPS II和APACHE II系统校准不佳，尽管它们显示出较高的区分度（SAPS II的受试者工作特征曲线下面积为0.95，APACHE II为0.94，MPM II0和MPM II24为0.90）。在该组患者中建立的以格拉斯哥昏迷评分为自变量的逻辑回归模型校准不如MPM II。该模型的区分度非常高，与APACHE II、SAPS II和MPM II系统的范围相当。
对于颅脑创伤患者，MPM II系统的表现优于APACHE II、SAPS II和格拉斯哥昏迷评分。如果我们的结果得到其他研究的支持，MPM II将是评估颅脑创伤患者疾病严重程度的合适工具，可应用于临床实践和临床研究。
