AN EVALUATION OF OUTCOME FROM INTENSIVE-CARE IN MAJOR MEDICAL-CENTERS
AN EVALUATION OF OUTCOME FROM INTENSIVE-CARE IN MAJOR MEDICAL-CENTERS
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DOI：
10.7326/0003-4819-104-3-410
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发表时间：
1986-03-01
影响因子：
39.2
通讯作者：
ZIMMERMAN, JE
中科院分区：
文献类型：
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作者：
KNAUS, WA;DRAPER, EA;ZIMMERMAN, JE
我们前瞻性研究了13家三级医院重症监护病房的5030例患者的治疗和结局。我们使用诊断、治疗适应症和急性心理学和慢性健康评估（APACHE）II评分，根据个体死亡风险对每家医院的患者进行分层。然后，我们使用组结果作为标准，比较实际和预测的死亡率。一家医院的结果明显更好，预测死亡69例，观察死亡41例（p < 0.001）。另一家医院的结果明显较差，死亡人数比预期多58%（p < 0.0001）。这些差异发生在特定的诊断类别内，对于单独的内科患者和内科和外科患者，并且与每个医院的重症监护室工作人员的互动和协调有关，而不是单位的行政结构，使用的专门治疗量或医院的教学状态。我们的研究结果支持这一假设，即重症监护的协调程度显着影响其有效性。
We prospectively studied treatment and outcome in 5030 patients in intensive care units at 13 tertiary care hospitals. We stratified each hospital''s patients by individual risk of death using diagnosis, indication for treatment, and Acute Psysiology and chronic Health Evaluation (APACHE) II score. We then compared actual and predicted death rates using group results as the standard. One hospital had significantly better results with 69 predicted but 41 observed deaths (p < 0.001). Another hospital had significantly inferior results with 58% more deaths than expected (p < 0.0001). These differences occurred within specific diagnostic categories, for medical patients alone and for medical and surgical patients combined, and were related more to the interaction and coordination of each hospital''s intensive care unit staff than to the unit''s administrative structure, amount of specialized treatment used, or the hospital''s teaching status. Our findings support the hypothesis that the degree of coordination of intensive care significantly influences its effectiveness.