A modified sequential organ failure assessment score for critical care triage.
A modified sequential organ failure assessment score for critical care triage.
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DOI：
10.1001/dmp.2010.40
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发表时间：
2010-12
影响因子：
2.7
通讯作者：
Orme, James F., Jr.
中科院分区：
文献类型：
--
作者：
Grissom, Colin K.;Brown, Samuel M.;Kuttler, Kathryn G.;Boltax, Jonathan P.;Jones, Jason;Jephson, Al R.;Orme, James F., Jr.
序贯器官衰竭评估（SOFA）评分已被推荐用于大量重症患者涌入时的分诊，但它需要对四个参数进行实验室检测，在资源有限的情况下可能不实用。我们假设一种只需进行一项实验室检测的改良SOFA（MSOFA）评分在预测患者预后方面与SOFA评分效果相同。
在回顾性推导之后，我们在一个有24张床位的内科、外科和创伤重症监护病房进行了一项前瞻性观察研究，确定了2008年全年所有入院患者的系列SOFA和MSOFA评分，并比较了它们预测死亡率和机械通气需求的能力。
该研究纳入了1770名患者（56%为男性），30天死亡率为10.5%。第1天的SOFA和MSOFA评分在预测死亡率方面效果相当，受试者工作特征曲线下面积（AUC）分别为0.83（95%置信区间：0.81 - 0.85）和0.84（95%置信区间0.82 - 0.85）（比较的p值为0.33）。第3天的SOFA和MSOFA对仍在重症监护病房的828名患者预测死亡率的AUC分别为0.78和0.79。第5天的评分在预测死亡率方面效果较差。第1天的SOFA和MSOFA对第3天机械通气需求预测的AUC分别为0.83和0.82。SOFA和MSOFA评分最高类别（>11分）的死亡率分别为53%和58%。
MSOFA在预测死亡率方面与SOFA相当，且在资源有限的环境中更易于实施，但将任一评分用作分诊工具都会排除许多原本可以存活的患者。
The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically-ill patients, but requires laboratory measurement of four parameters which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only one laboratory measurement would predict patient outcome as well as the SOFA score. After a retrospective derivation, in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during calendar year 2008 and compared ability to predict mortality and need for mechanical ventilation. 1,770 patients (56% male) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% CI: 0.81-0.85) and 0.84 (95% CI 0.82-0.85) respectively (p=0.33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the ICU with an AUC of 0.78 and 0.79 respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted need for mechanical ventilation on Day 3 with an AUC of 0.83 and 0.82 respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58% respectively. The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.
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影响因子：
14.6
作者：
Christian, Michael D.;Hawryluck, Laura;Burkle, Frederick M., Jr.
通讯作者：
Burkle, Frederick M., Jr.
影响因子：
10.7
作者：
Khan, Z.;Hulme, J.;Sherwood, N.
通讯作者：
Sherwood, N.
影响因子：
8.8
作者：
Pandharipande, Pratik P.;Shintani, Ayumi K.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
影响因子：
38.9
作者：
Cabré, L;Mancebo, J;Martín, MC
通讯作者：
Martín, MC
影响因子：
158.5
作者：
Abdel-Ghafar, Abdel-Nasser;Chotpitayasunondh, Tawee;Uyeki, Timothy M.
通讯作者：
Uyeki, Timothy M.