Comparison of outcome from intensive care admission after adjustment for case mix by the APACHE III prognostic system
Comparison of outcome from intensive care admission after adjustment for case mix by the APACHE III prognostic system
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DOI：
10.1378/chest.115.3.802
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发表时间：
1999-03-01
期刊：
影响因子：
9.6
通讯作者：
Smith, GB
中科院分区：
文献类型：
--
作者：
Pappachan, JV;Millar, B;Smith, GB
研究目的：评价急性生理、年龄、慢性健康状况评价III（APACHE III）评分系统在英国普通成人ICU竞赛中的应用。设计：前瞻性、非干预性、队列研究。设置：英格兰西南部离散地区的17个普通成人ICU。患者：1993年4月1日至1995年12月31日期间收治的12，793例患者，测量：收集了所有入住研究单位的患者的社会人口统计学和疾病严重程度数据。应用正式的拟合优度检验，并将观察到的死亡率与使用APACHE III系统预测的死亡率进行比较。结果：ICU组作为一个整体，风险调整的标准化死亡率比（SMR）为1.23（95%置信区间，1.12-1.25）。对于17个ICU中的11个，SMR显著大于1（p < 0.05）。根据霍斯默-勒梅肖统计数据的检验，校准效果很差（H-2 = 312.54; C-2 = 332.85; df = 8; p < 0.01），但模型判别力较好，总正确分类率为82.9%，受试者工作特征曲线下面积为0.89。在本研究中，使用APACHE III系统调整病例组合后观察到的超额死亡率可能是与美国相比重症监护表现较差或APACHE III方程无法拟合英国的结果。数据
Study objectives: To evaluate the acute physiology, age, chronic health evaluation III (APACHE III) scoring system in the contest of general adult ICUs in the United Kingdom.Design: Prospective, noninterventional, cohort study.Setting: Seventeen general adult ICUs in a discrete area of southwest England.Patients: 12,793 patients admitted between April 1, 1993 and December 31, 1995,Measurements: Sociodemographic and severity-of-illness data were collected for all patients admitted to the study units. Formal goodness-of-fit tests were applied and observed mortality was compared with that predicted by using the APACHE III system,Results: For the group of ICUs as a whole, the risk-adjusted standardized mortality ratio (SMR) was 1.23 (95% confidence intervals, 1.12-1.25). For 11 out of 17 ICUs, the SMR was significantly greater than unity (p < 0.05). Calibration, as tested by Hosmer-Lemeshow statistics, was poor (H-2 = 312.54; C-2 = 332.85; df = 8; p < 0.01); however, model discrimination was good with a total correct classification rate of 82.9% and an area under the receiver operating characteristic curve of 0.89.Conclusions: The excess mortality observed after case-mix adjustment using the APACHE III system in this study may be the result of either poor intensive care performance as compared,with the United States or a failure of the APACHE III equation to fit the UK. data.