Interobserver variability in data collection of the APACHE II score in teaching and community hospitals
Interobserver variability in data collection of the APACHE II score in teaching and community hospitals
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DOI：
10.1097/00003246-199909000-00046
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发表时间：
1999-09-01
影响因子：
8.8
通讯作者：
Sibbald, WJ
中科院分区：
文献类型：
--
作者：
Chen, LM;Martin, CM;Sibbald, WJ
目的：检验急性生理和慢性健康评估（APACHE） II评分的观察者间可靠性，并确定数据收集变异性的主要原因。设计：描述性比较分析。环境：两所教学医院和六所社区医院的九间重症监护室。研究对象：从网络数据库中随机抽取342例患者记录。干预:没有。测量结果及主要结果：重新提取数据并与原始记录进行比较。使用kappa统计比较来自APACHE II评分系统的个体生理积分（而不是实际生理值）。使用类间相关系数和Bland-Aitman图对连续变量的成对测量进行比较，发现大多数人口统计学、入院和出院数据具有良好的一致性。在88%的病例中，系统故障需要入住重症监护病房，但只有66%的数据收集者同意确切的入院诊断。对于APACHE II评分组成部分，kappa统计值从格拉斯哥昏迷量表点的0.315到年龄点的0.976不等。在一些患者记录中，关于APACHE II模型得出的死亡概率的重大分歧是显而易见的。然而，各组患者对APACHE II评分的总体一致性很好，平均评分无显著差异（20.2 vs. 20.1; p = .758），重新提取数据的预测死亡率为30%，与原始数据的27%预测死亡率相似（p = .380）。结论：数据收集的可靠性在APACHE II死亡概率模型的不同组成部分差异很大。某些组成部分的显著差异表明，机构之间或数据收集者之间缺乏明确的定义和一致数据收集的时间安排。尽管如此，数据收集产生的变异性似乎是随机分布的，因此组均值比较是有效的。
Objectives: To examine interobserver reliability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score and identify major causes of variability in data collection,Design: Descriptive, comparative analysis.Setting: Nine intensive care units in two teaching and six community hospitalsSubjects: A random sample of 342 patient records selected from a network database.Intervention: None.Measurements and Main Results: Data were reabstracted and compared with the original records. Individual physiologic points derived from the APACHE II scoring system (instead of the actual physiologic values) were compared using the kappa statistic. Paired measurements of the continuous variables were compared using the interclass correlation coefficient and Bland-Aitman plots, Excellent agreement was found in most demographic, admission, and discharge data. The system failure requiring intensive care unit admission was consistently identified by both data collectors in 88% of cases, but only 66% agreed on the exact admitting diagnosis, For APACHE II score components, the kappa statistic ranged from 0.315 for the Glasgow Coma Scale point to 0.976 for the age point. Significant disagreement regarding the probability of death derived from the APACHE II model was evident in some patient records. Overall agreement among groups of patients regarding the APACHE II score was good, however, with no significant difference in the mean score (20.2 vs. 20.1; p = .758), The predicted mortality from the reabstracted data was 30%, similar to the 27% predicted mortality from the original data (p = .380),Conclusion: Reliability of data collection varied widely in different components of the APACHE II probability-of-death model. Significant discrepancies in some components suggested a lack of explicit definitions and timing for consistent data collection between institutions or between data collectors. Nonetheless, variability resulting from data collection appears to be randomly distributed, so that comparisons of group means are valid.