Applicability and relevance of models that predict short term outcome after intracerebral haemorrhage
Applicability and relevance of models that predict short term outcome after intracerebral haemorrhage
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DOI：
10.1136/jnnp.2004.048223
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发表时间：
2005-06-01
影响因子：
11
通讯作者：
Rinkel, GJE
中科院分区：
文献类型：
--
作者：
Ariesen, MJ;Algra, A;Rinkel, GJE
目的：已经发表了几种预测脑出血（ICH）后短期结局的模型，然而，这些模型很少用于临床实践中的治疗决策。本研究进行，以确定目前的模型预测ICH后的短期结果，并评估其临床适用性和相关性的治疗decisions.Methods：MEDLINE检索1966年至2003年6月和研究，如果他们符合预定义的标准。提取多变量模型的回归系数。两名神经科医生独立评估了模型在临床实践中的适用性。为了评估每个模型的临床相关性和准确性，在122名患者的验证系列中，计算了这些患者中死亡或不良结局概率>= 95%的比例和实际30天病死率。结果：共建立了18个预测模型，其中14个模型易于应用。在验证系列中，死亡或不良结局概率>= 95%的患者比例范围为0%至43%（中位数为23%）。这些患者的30天病死率范围为75%至100%（中位数93%）。ROC曲线下面积在0.81 ~ 0.90之间。结论：大多数模型易于应用，且产生死亡或不良结局的概率较高。然而，只有一小部分患者具有如此高的概率，并且30天病死率并不总是能够正确预测。因此，目前的模型在分诊方面的相关性有限，但可用于估计个体患者的生存机会。
Objectives: Several models for prediction of short term outcome after intracerebral haemorrhage (ICH) have been published, however, these are rarely used in clinical practice for treatment decisions. This study was conducted to identify current models for prediction of short term outcome after ICH and to evaluate their clinical applicability and relevance in treatment decisions.Methods: MEDLINE was searched from 1966 to June 2003 and studies were included if they met predefined criteria. Regression coefficients of multivariate models were extracted. Two neurologists independently evaluated the models for applicability in clinical practice. To assess clinical relevance and accuracy of each model, in a validation series of 122 patients the proportion with a >= 95% probability of death or poor outcome and the actual 30 day case fatality in these patients were calculated. Receiver operator characteristic (ROC) curves were computed for assessment of discriminatory power.Results: A total of 18 prognostic models were identified, of which 14 appeared easy to apply. In the validation series, the proportion of patients with a >= 95% probability of death or poor outcome ranged from 0% to 43% ( median 23%). The 30 day case fatality in these patients ranged from 75% to 100% ( median 93%). The area under the ROC curves ranged from 0.81 to 0.90.Conclusions: Most models are easy to apply and can generate a high probability of death or poor outcome. However, only a small proportion of patients have such a high probability, and 30 day case fatality is not always correctly predicted. Therefore, current models have limited relevance in triage, but can be used to estimate the chances of survival of individual patients.