Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality. Acute Physiology and Chronic Health Evaluation. Mainz Emergency Evaluation System.
Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality. Acute Physiology and Chronic Health Evaluation. Mainz Emergency Evaluation System.
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DOI：
10.1186/cc973
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Gasparovic V
中科院分区：
文献类型：
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作者：
Grmec S;Gasparovic V
有许多院前描述性评分系统，尚不确定它们是否能有效评估疾病的严重程度，以及它们是否在估计疾病结局中具有预后作用（与预后评分系统急性生理学和慢性健康评价[APACHE] II相比）。本研究的目的是评估各种评分系统在预测非创伤性昏迷患者预后方面的价值，并评估心理状态测量与预后相关的重要性。在院前环境中，测量每位患者的Mainz急诊评估系统（MEES）和格拉斯哥昏迷量表（GCS）的干预后值。在入院当天记录APACHE II评分。这项研究进行了2年的时间（从1996年1月至1998年10月），并包括286例连续患者（168名男性，118名女性）谁住院的非创伤性昏迷。未纳入16岁以下的患者。他们的年龄从16岁到87岁不等，平均值±标准差为51.8 ± 16.9岁。采用χ2方法测量敏感性、特异性和正确预测结果，并采用4个严重程度评分。使用Youden指数确定每个评分系统中的最佳截止点。使用Z评分计算Youden指数的差异。对于每个评分，获得受试者工作特征（ROC）曲线。使用Z评分计算ROC的差异。P < 0.05为有统计学意义。对于死亡率的预测，APACHE II的最佳截止点为19，MEES为18，GCS为5。尤登指数的最佳截止值分别为APACHE II 0.63、MEES 0.61和GCS 0.65。APACHE II、MEES和GCS的正确预测率分别为79.9%、78.3%和81.9%。APACHE II、MEES和GCS的ROC曲线下面积（平均值±标准误）分别为0.86 ± 0.02、0.84 ± 0.06和0.88 ± 0.03。APACHE II、MEES和GCS评分在正确预测结局、Youden指数或ROC曲线下面积方面无统计学差异。APACHE II并不比院前描述性评分系统（MEES和GCS）好多少。APACHE Ⅱ和MEES不能代替GCS评估非创伤性昏迷患者的病情严重程度或预测死亡率。对于死亡率的评估，GCS评分为这些患者提供了最佳指标（简单，耗时少，在紧急情况下有效）。
There are numerous prehosital descriptive scoring systems, and it is uncertain whether they are efficient in assessing of the severity of illness and whether they have a prognostic role in the estimation of the illness outcome (in comparison with that of the prognostic scoring system Acute Physiology and Chronic Health Evaluation [APACHE] II). The purpose of the present study was to assess the value of the various scoring systems in predicting outcome in nontraumatic coma patients and to evaluate the importance of mental status measurement in relation to outcome. In a prehospital setting, postintervention values of the Mainz Emergency Evaluation System (MEES) and Glasgow Coma Scale (GCS) were measured for each patient. The APACHE II score was recorded on the day of admission to the hospital. This study was undertaken over a 2-year period (from January 1996 to October 1998), and included 286 consecutive patients (168 men, 118 women) who were hospitalized for nontraumatic coma. Patients younger than 16 years were not included. Their age varied from 16 to 87 years, with mean ± standard deviation of 51.8 ± 16.9 years. Sensitivity, specificity and correct prediction of outcome were measured using the χ2 method, with four severity scores. The best cutoff point in each scoring system was determined using the Youden index. The difference in Youden index was calculated using the Z score. For each score, the receiver operating characteristic (ROC) curve was obtained. The difference in ROC was calculated using the Z score. P < 0.05 was considered statistically significant. For prediction of mortality, the best cutoff points were 19 for APACHE II, 18 for MEES and 5 for GCS. The best cutoffs for the Youden index were 0.63 for APACHE II, 0.61 for MEES and 0.65 for GCS. The correct prediction of outcome was achieved in 79.9% for APACHE II, 78.3% for MEES and 81.9% for GCS. The area under the ROC curve (mean ± standard error) was 0.86 ± 0.02 for APACHE II, 0.84 ± 0.06 for MEES and 0.88 ± 0.03 for GCS. There were no statistically significant differences among APACHE II, MEES and GCS scores in terms of correct prediction of outcome, Youden index or area under ROC curve. APACHE II is not much better than prehospital descriptive scoring systems (MEES and GCS). APACHE II and MEES should not replace GCS in assessment of illness severity or in prediction of mortality in nontraumatic coma. For the assessment of mortality, the GCS score provides the best indicator for these patients (simplicity, less time-consuming and effective in an emergency situation.