The prospective testing of the accuracy of a prognosis prediction score in pleural infection

胸膜感染是指在肺和胸壁之间积聚受感染的液体。每年（美国和英国）大约有8万例新病例，其中35%要么是致命的，要么需要胸部手术。标准的治疗包括抗生素和通过胸腔内的一根管子引流感染的液体。如果手术失败，则需要手术引流，但我们目前没有可靠的方法来确定哪些患者需要手术。在需要的情况下，及时手术可能挽救生命，但它也与重大并发症有关，并导致大量疼痛。因此，针对那些最需要手术的人进行手术是很重要的。这项研究将测试一种预测工具，它可以让我们确定？高的风险?谁可能从手术中获益最多。建议的测试是在入院时计算的风险预测评分。以前的数据表明，根据临床实践中常规收集的五项检查结果，可能会预测哪些患者会死于胸膜感染。虽然这些预测因素似乎非常强大，但它们需要进行测试。现实世界吗?使用。此外，其他研究表明，导致感染的细菌类型可能预测死亡，这些因素也将作为可能的预测因素进行探索。本研究将收集来自英国、欧洲、美国和远东地区的550例胸膜感染患者的信息。所有患者都将接受最好的治疗，包括抗生素、胸腔引流和必要时的手术。我们会记录哪些病人死亡或需要手术。在研究结束时，我们将计算？预测因子？确定死亡风险高的患者。进行这项研究的团队之前已经成功地完成了该领域的许多研究。该研究团队总共拥有4500万美元的临床研究资金。如果这里测试的分数被证明是预测哪些患者会表现不佳的好方法，这可以立即用于改变我们治疗这种疾病患者的方式。

Pleural infection describes infected fluid collecting between the lung and chest wall. There are around 80,000 new cases each year (US+UK), of which 35% are either fatal or require chest surgery. Standard treatment involves antibiotics and drainage of infected fluid, achieved through a tube placed in the chest. If this fails, surgical drainage is required, but we currently do not have a reliable way of identifying which patients will need surgery. Prompt surgery may be life saving in needy cases, but it is also associated with major complications and results in a substantial amount of pain. Thus, targeting surgery to those who need it most is important. This study will test a prediction tool which may allow us to identify ?high risk? who may benefit most from surgery. The proposed test is a risk prediction score calculated on admission to hospital. Previous data suggests it may be possible to predict patients who would die from their pleural infection from five test results which are routinely collected in clinical practice. While these predictors seem very powerful, they need to be tested in ?real world? use. In addition, other work suggests that the type of bacteria responsible for the infection may predict death, and these factors will also be explored as possible ?predictors?. This study will collect information about 550 pleural infection patients, recruited from UK, Europe, USA and the Far East. All patients will receive the best available treatment, including antibiotics, chest drainage and surgery if needed. We will record which patients die or need surgery. At the end of the study, we will calculate whether the ?predictors? identify patients at high risk of death.The team conducting this research have previously successfully completed many studies in this area. Together the research team holds #45m of clinical research funding. If the score tested here turns out to be a good way predict which patients will do badly, this can be immediately used to change how we treat patients with this disease.