集中治療における無益性の特定
S Atkinson1, D Bihari, M Smithies
1Department of Surgery, Guy's Hospital, London, UK.
Lancet (London, England)
|October 29, 1994
まとめ
この研究では,集中治療患者の死亡率を予測するための臓器不全スコアを開発しました. このスコアは,死亡する患者の95.6%を正確に特定し,集中治療のためのリソースの割り当てを支援しました.
科学分野:
- クリティカルケア・メディシン
- 健康経済学 医療経済学
- 予測モデリング 予測モデリング
背景:
- 集中治療費が上昇しており,生存者でない患者の早期発見が求められています.
- 重症患者の寿命を延ばすのは,資源を圧迫する.
- 継続的な集中治療から利益を得る可能性が低い患者を認識する必要性が存在します.
研究 の 目的:
- 集中治療室での死亡率を予測するための修正されたAPACHE IIスコアの有用性を評価する.
- 予測された結果に基づいて集中治療資源の割り当ての費用対効果を評価する.
- 集中治療における早期無益性予測の正確性と意味を決定する.
主な方法:
- 日々の結果を予測するために,修正されたAPACHE IIスコア (臓器不全スコア) を利用しました.
- 3600人の集中治療患者のデータを分析した.
- 死亡率の予測のための計算された感度,特異性,偽陽性率.
主要な成果:
- 死亡が予測された137人の患者のうち,131人 (95.6%) が90日以内に死亡しました (特異性99.8%,感度23.4%).
- 死ぬと予測された患者は,集中治療費の16.7% (総支出の16.7%) を負担しました.
- 予測された非生存者の生存期間の中央値は2日であり,生存者一人当たりの集中治療費が高くなりました.
結論:
- 修正されたAPACHE IIスコアは,無駄な集中治療を特定する可能性を示している.
- 将来の使用は,資源配分を最適化することができるが,潜在的な生存者からのケアを差し控えるリスクが伴う.
- 早期の無益性予測の倫理的,臨床的影響については,慎重に検討する必要があります.
キーワード:
アパケ (Apache) とは,アパケ (APACHE) とは,アパケ (APACHE) とは,アパケ (APACHE) とは,アパケ (APACHE) とは死と安楽死についてガイズ病院 (ロンドン)保健医療と公衆衛生についてさらに関連する動画
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