Severity Scoring in the Critically III Part 1-Interpretation and Accuracy of Outcome Prediction Scoring Systems
Severity Scoring in the Critically III Part 1-Interpretation and Accuracy of Outcome Prediction Scoring Systems
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DOI：
10.1378/chest.11-0330
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发表时间：
2012-01-01
期刊：
影响因子：
9.6
通讯作者：
Badawi, Omar
中科院分区：
文献类型：
--
作者：
Breslow, Michael J.;Badawi, Omar
这篇综述考察了使用评分系统来评估ICU的表现。APACHE(急性生理学和慢性健康评估)、MPM(死亡率概率模型)和SAPS(简化急性生理学评分)是当今使用的三种主要ICU评分系统。所有这三种方法的核心都是使用生理数据进行严重程度调整。数据集的大小、性质和时间范围的差异转化为数据抽象的准确性和难度的细微差异。APACHE IV提供ICU和医院对死亡率和住院时间的预测，而MPM和SAPS只提供医院死亡率预测(尽管从MPM数据元素生成的新算法可能会充分预测ICU的住院时间)。评分系统的主要用途是评估ICU的表现，研究队列中的实际结果与预测结果的比率提供了与参考ICU的表现比较。评分系统预测的可靠性取决于抽象数据的完整性和准确性；因此，ICU必须实施强有力的数据质量控制过程。比率的顺应性与样本量成反比，必须注意避免过度解释结果的变化。ICU的结构和流程问题也会影响评分系统的绩效衡量。尽管有很好的辨别力和校准，评分系统只有10%到15%的美国ICU使用。没有ICU性能数据，提高质量和降低成本的希望微乎其微。目前对文件透明度和计算机化的要求可能会推动今后使用ICU评分系统。《胸腔》2012；141(1)：245-252
This review examines the use of scoring systems to assess ICU performance. APACHE (Acute Physiology and Chronic Health Evaluation), MPM (mortality probability model), and SAPS (simplified acute physiology score) are the three major ICU scoring systems in use today. Central to all three is the use of physiologic data for severity adjustment. Differences in the size, nature, and time horizon of the data set translate into minor differences in accuracy and difficulty of data abstraction. APACHE IV provides ICU and hospital predictions for mortality and length of stay, whereas MPM and SAPS only provide hospital mortality predictions (although new algorithms generated from MPM data elements may predict ICU length of stay adequately). The primary use of scoring systems is for assessing ICU performance, with the ratio of actual-to-predicted outcomes in the study cohort providing performance comparisons to the reference ICUs. The reliability of scoring system predictions depends on the completeness and accuracy of the abstracted data; accordingly, ICUs must implement robust data quality control processes. CIs of the ratios are inversely related to sample size, and care must be taken to avoid overinterpreting changes in outcomes. ICU structural and process issues also can affect scoring system performance measures. Despite good discrimination and calibration, scoring systems are used in only 10% to 15% of US ICUs. Without ICU performance data, there is little hope of improving quality and reducing costs. Current demands for transparency and computerization of documentation are likely to drive future use of ICU scoring systems. CHEST 2012; 141(1):245-252