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題 名 | A Comparative Study of Clinical Severity Scoring Systems in ICUs in Taiwan=臺灣地區加護病房臨床嚴重度評估系統應用之比較研究 |
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作 者 | 湯澡薰; 楊哲銘; 莊淇源; 張明利; 黃玉純; 黃錦鳳; | 書刊名 | 慈濟醫學 |
卷 期 | 17:4 民94.08 |
頁 次 | 頁239-245+298 |
分類號 | 419.52 |
關鍵詞 | 嚴重度; 加護病房; 急性生理年齡慢性健康評估第二版; Severity of illness; ICU; APACHE Ⅱ; |
語 文 | 英文(English) |
中文摘要 | 目的:嚴重度指標因對醫療服務評估及監控的日益受到重視而蓬勃發展,APACHE II是臺灣唯一被廣泛使用的系統。本研究的主要目的為評估不同病情嚴重度指標在臺灣地區加護病房的結果預測力。材料與方法:本研究之目標係比較五個最常用的病情嚴重指標:MODS,TISS,APACHE II,MPM24,SAPS,針對所有病人樣本都記錄五個指標值,以進行相關性及結果預測力的比較。資料收集是在一個600床區域醫院的加護病房收集了101個病例。結果:結果顯示該五者顯著相關,以ROC曲線評估死亡預測的正確性界於0.71至0.88之間;醫療支出預測力皆差,決定係數最高僅達0.064;APACHE II的預測力即使不是最佳也和各大系統相近;MODS在外科病例的支出預測力上可達決定係數0.331。結論:研究結果顯示臺灣地區加護病房選用APACEE II可達效度上的要求,MODS系統對醫療費用的預測力較高,而TISS系統則不如預期的與醫療支出相關。 |
英文摘要 | Objective: The objective of this study is to compare the performance of five commonly applied severity measures. Severity scoring systems have been developed in response to an increased emphasis on the evaluation and monitoring of health care services. The Acute Physiology and Chronic Health Evaluation (APACHE) II system is the only one that has been widely applied in Taiwan. This study is designed to ascertain the outcome prediction abilities of various severity measures in ICUs in Taiwan. Materials and Methods: All five severity instruments were applied to the same patient sample to assess the correlations and relative performance of all five systems. The data collection process was done in a 600-bed regional hospital with 101 valid cases recorded. Results: All five major severity scores, Multiple Organ Dysfunction Score (MODS), Therapeutic Intervention Scoring System (TISS), APACHE II, Mortality Probability Model 24 (MPM24), and Simplified Acute Physiology Score (SAPS), significantly correlated with each other. The accuracy of mortality prediction of each measure ranged from 0.71 to 0.88 as illustrated by the area under the receiver operating characteristics (ROC) curve. The predictive power of each severity measure against the total expenses for each admission was poor in light of the fact that the only significant coefficient of determination was as low as 0.064. APACHE II’ performance was as good as all the other systems. MODS performed better in predicting costs of surgical cases with the coefficient of determination reaching 0.331. Conclusions: The application of APACHE II in Taiwan’s ICUs as the only standard severity measure is justifiable based on our findings. MODS appears to have a better expense predictive power. However, the expense predictive power of TISS was not as good as expected. |
本系統中英文摘要資訊取自各篇刊載內容。