四个风险评分的外部有效性预测了手术后30天的死亡率
Frederick Torlot1, Chang-Yang Yew1, Jennifer R Reilly2,3
1Royal Perth Hospital, Perth, Australia.
BJA open
|August 17, 2023
概括
手术结果风险工具 (SORT) 在四个风险分数中最好地预测了30天的手术死亡率. 虽然准确地识别高风险患者,但SORT和其他人过度预测绝对死亡风险.
科学领域:
- 手术结果研究研究.
- 医疗保健服务研究 医疗服务研究
- 医学中的预测分析.
背景情况:
- 手术风险预测工具有助于共享决策和资源分配.
- 在实施这些工具之前,对目标人群进行外部验证至关重要.
研究的目的:
- 以回顾评估和比较四种外科风险预测工具的性能.
- 评估这些工具用于预测30天死亡率的歧视和校准.
主要方法:
- 对手术患者预测的30天死亡风险 (2014-2021) 的回顾性推导.
- 使用的外科结果风险工具 (SORT),NZRISK,POSSUM和P-POSSUM.
- 评估风险评分歧视,使用区域下接收机运营商特征 (AUROC) 统计数据和评估校准.
主要成果:
- 所有四个风险分数都显示了30天死亡率的高度歧视 (AUROC范围:0.881-0.922).
- SORT显示出最好的歧视和校准,尽管所有得分都始终预测过度的风险.
- SORT风险值确定了大多数死亡和并发症;校准性能随着时间的推移而变化.
结论:
- SORT成为预测30天外科后死亡率的优越风险得分.
- 基于SORT的风险分层 (低,中,高) 可以指导外科手术期间的资源配置.
- 目前的工具缺乏足够的校准,以基于绝对风险预测的共享决策.
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