在入院前患者报告结果的可靠性,通过代理进行术后评估:一个前性,多中心观察性研究
Julius J Grunow1, Leonie Hartmann1, Bernhard Ulm2,3
1Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charitéplatz 1, 10117, Berlin, Germany.
Critical care (London, England)
|May 19, 2025
概括
使用患者报告的结果措施对患者入院前状态的代理评估是不可靠的,特别是对于ICU患者. 建议在使用代理数据时谨慎使用,因为有显著的偏差和差异超出了临床重要差异的最小值.
科学领域:
- 医学研究 医学研究
- 患者的治疗结果.
- 医疗保健的质量 医疗保健的质量
背景情况:
- 患者报告的结果指标 (PROM) 对于预后和治疗决策至关重要.
- 代理收集PROM数据是常见的,但其可靠性未得到充分研究.
- 评估ICU入院前状态的可靠性对于准确的临床和研究应用至关重要.
研究的目的:
- 使用PROMs评估预ICU入院状态的代理评估的可靠性.
- 确定ICU设置是否影响代理报告结果的可靠性.
- 通过各种验证的问卷来比较患者和代理响应.
主要方法:
- 在两个德国大学医院进行的前性多中心观察研究.
- 包括手术成年患者可用代理,使用SF-36,EQ-5D-5L,WHODAS 2.0,IADL和巴特尔指数进行评估.
- 通过布兰德-阿尔特曼图表和科恩的卡帕分析可靠性,比较患者和代理响应.
主要成果:
- 代理评级显示可靠性不足,所有PROMs的95%一致度超过了临床重要差异最小值 (MCID).
- 在WHODAS 2.0,IADL和SF-36子集的ICU患者的代理评级中观察到显著的偏差.
- 在ICU和非ICU队列中都出现了EQ-5D-5L评级的偏差;仅通过科恩的kappa通过IADL记录了中度可靠性.
结论:
- 使用这些PROMs进行准入前状态的代理评估是不可靠的,应谨慎使用.
- 代理报告中的重大偏差,特别是对于ICU患者,会影响入院前状态数据的有效性.
- 需要进一步的研究来理解和减轻代理报告结果中的差异.
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