ICU患者の重症度のモデリング. システムアップデートとは,システムアップデートです
1School of Public Health, University of Massachusetts, Amherst 01003.
JAMA
|October 5, 1994
まとめ
APACHE III,SAPS II,MPM IIなどの集中治療室 (ICU) の死亡率予測システムの最近の改訂は,予後と臨床試験の層分化に良いパフォーマンスを示しています. さらに直接的な比較が必要である.
科学分野:
- クリティカルケア・メディシン
- 医療サービス 研究 医療サービス
- バイオ統計学 バイオ統計学
背景:
- 集中治療室 (ICU) の患者の病院死亡率の推定は,臨床的意思決定とパフォーマンス評価において極めて重要です.
- 精度を高めるために,いくつかの重症度スコアリングシステムが開発され,修正されています.
研究 の 目的:
- 成人ICU患者の死亡率予測システムの最近の改訂をレビューする.
- これらのシステムのコンポーネントと潜在的な用途を比較する.
主な方法:
- 死亡率推定システムを紹介した論文の体系的なレビュー.
- APACHE III,SAPS II,MPM IIの変数,データベースの特性,および報告されたモデルパフォーマンスの評価.
主要な成果:
- APACHE IIIとSAPS IIは24時間ICUでの最悪値を使用し,MPM IIは複数の時間点 (入院,24時間,48時間,72時間) でモデルを提供しています.
- SAPS II および MPM II モデルは完全に実装可能であり,APACHE III ウェイトはプロプライエタリです.
- すべてのシステムは良好なパフォーマンスを示した (ROC曲線の下の面積);SAPS IIとMPM IIは良好な適合性を示した.
結論:
- レビューされたすべての死亡率予測モデルは,良好なパフォーマンスを報告した厳格な研究に基づいています.
- これらのシステムは,予後評価,ICUのパフォーマンス比較,臨床試験の患者層分化に役立ちます.
- 共通の患者コホートを使用した直接比較が推奨され,その有用性をさらに検証します.
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