Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery
Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery
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DOI：
10.1093/intqhc/15.1.7
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发表时间：
2003-02-01
影响因子：
2.6
通讯作者：
Treasure, T
中科院分区：
文献类型：
--
作者：
Spiegelhalter, D;Grigg, O;Treasure, T
目标。目的：探讨风险调整序贯概率比检验在监测临床不良结果累积发生中的作用。对三个纵向数据集进行了回顾分析。1979年至1997年由Harold Shipman照顾的65岁及以上患者，1984至1995年间在布里斯托尔皇家医院接受儿科心脏手术的1岁以下患者，英国伦敦心脏外科医生团队接受心脏手术的成年患者。年死亡率和30天死亡率。使用合理的界限，该程序本可以在1991年心脏外科登记簿出版后在布里斯托尔发出警报，并在1985年或1997年对哈罗德·希普曼发出警报，具体取决于数据源和比较器。心脏外科医生没有表现出明显的偏离预期的表现。经风险调整的序贯概率检验易于实施，可应用于各种情况，并且可能对检测过去不同表现的特定实例很有用。在前瞻性监测不良临床结果的背景下，这项技术和相关技术的使用值得进一步关注。
Objective. To investigate the use of the risk-adjusted sequential probability ratio test in monitoring the cumulative occurrence of adverse clinical outcomes.Design. Retrospective analysis of three longitudinal datasets.Subjects. Patients aged 65 years and over under the care of Harold Shipman between 1979 and 1997, patients under 1 year of age undergoing paediatric heart surgery in Bristol Royal Infirmary between 1984 and 1995, adult patients receiving cardiac surgery from a team of cardiac surgeons in London, UK.Main outcome measure. Annual and 30-day mortality rates.Results. Using reasonable boundaries, the procedure could have indicated an 'alarm' in Bristol after publication of the 1991 Cardiac Surgical Register, and in 1985 or 1997 for Harold Shipman depending on the data source and the comparator. The cardiac surgeons showed no significant deviation from expected performance.Conclusions. The risk-adjusted sequential probability test is simple to implement, can be applied in a variety of contexts, and might have been useful to detect specific instances of past divergent performance. The use of this and related techniques deserves further attention in the context of prospectively monitoring adverse clinical outcomes.