非幸存者的ICU入院和出院诊断之间的准确性:一项回顾性队列研究
Hannah H M Hulsewe1, Thom Wilbers2, Frank van Rosmalen3
1Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
入院和出院之间的重症监护室 (ICU) 诊断的差异很常见. 然而,这些诊断变化对已故ICU患者预测的住院死亡率的影响很小.
科学领域:
- 关键护理医学 关键护理医学
- 医疗信息学 医疗信息学
- 医学预测 医学预测
背景情况:
- 准确的入院诊断对于预测模型至关重要,例如在重症监护室 (ICU) 中使用的APACHE IV.
- 诊断记录中的差异或患者住院期间的变化可能会影响死亡率预测.
研究的目的:
- 评估ICU入院和出院诊断之间的差异对预测的住院死亡率的影响.
- 使用入院与出院诊断量化预测死亡率之间的一致性.
主要方法:
- 已故ICU患者的回顾性分析 (2018-2020年).
- 使用APACHE IV代码对最多两个入院诊断和最多两个出院诊断进行比较.
- 将差异分类为注册错误或诊断变化.
- 使用两组诊断和通过平均差异和类内相关系数 (ICC) 的一致性评估来计算APACHE IV预测的死亡率.
主要成果:
- 在5633名ICU患者中,886人 (16%) 死亡.
- 在363名 (41%) 患者中没有诊断差异;在138名 (16%),注册错误;在416名 (47%) 的诊断变化.
- 预测死亡率的平均差异为0.019 (95% CI:0.015-0.024),具有很高的一致性 (ICC = 0.97).
结论:
- 在ICU入院和出院诊断之间经常存在差异.
- 这些诊断差异只会导致已故ICU患者预测死亡率的微小变化.
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