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101.
Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome 总被引:1,自引:0,他引:1
Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different
scoring systems for head injury in a neurosurgical intensive care unit (NICU).
Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health
Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients
before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was
defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities
of Daily Living (Index of ADL).
Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital.
Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years.
Patients less than 14 years old were not included.
Interventions: None.
Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems.
The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The
difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than
0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system
was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II
and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden
index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating
Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical
differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC
curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value
in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly
better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological
variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction
of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct
prediction outcome, Youden index and the area under the ROC curve.
Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment.
But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables
excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and
economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides
better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only
for hospital and late mortality, but also for functional outcome.
Received: 22 May 1995 Accepted: 2 September 1996 相似文献
102.
J D Lee K H Shin S N Cho J S Shin M G Lee W I Yang C Y Park H S Yoo J T Lee O D Awh 《European journal of nuclear medicine》1992,19(12):1011-1015
Immunoscintigraphy with radiolabelled monoclonal antibodies is widely used to detect solid tumours, but only a few trials have been carried out concerning the specific in vivo localization of an inflammatory process. The purpose of this study was to investigate the detectability of tuberculous foci utilizing this method with radiolabelled bacillus Calmette-Guérin (BCG)-specific F(ab')2 in rabbits. All of the tuberculous lesions (n = 8) were clearly visualized on serial scintigraphy for up to 48 h after injection of the antibody. Immunohistochemical and Ziel-Neelson staining of the tuberculous lesions confirmed the presence of the tuberculous antigens and bacilli. It failed to demonstrate any sustained retention of the BCG-specific antibody fragment in the control group with syphilitic orchitis (n = 2). Therefore, the specific in vivo localization of tuberculosis is feasible by immunoscintigraphy. 相似文献
103.
104.
105.
Kenneth J. Sher PhD Arthur I. Alterman PhD 《Alcoholism, clinical and experimental research》1988,12(2):233-238
Although Tarter et al.'s (1977) HK/MBD questionnaire has been found useful in subtyping populations of clinical alcoholics, its potential utility in nonclinical populations has yet to be determined. The current study examined the family history, personality, and substance use/abuse correlates of Tarter et al.'s HK/MBD questionnaire and factor analytically derived subscales (Alterman and McLellan, 1986) in a nonclinical sample of 580 young, adult males. In addition, a factor analysis of the HK/MBD questionnaire was undertaken to assess the extent to which the factor structure determined on a clinical alcoholic sample replicates in a nonclinical sample. Results indicated that each of the HK/MBD subscales showed relatively unique patterns of correlations with the various personality measures employed suggesting that they are measuring separate constructs. Perhaps of greatest importance, the HK/MBD items that appear to be of greatest relevance for understanding substance use/abuse are those related to antisocial behavior. Finally, the factor structure of the HK/MBD questionnaire in the nonclinical sample was found to be quite similar to the structure obtained in a clinical sample. These results demonstrate the multidimensional structure of the HK/MBD questionnaire and the utility of using the more homogeneous subscales in research with both clinical and nonclinical samples. 相似文献
106.
Scott L. Nyberg Arthur J. Matas Walter K. Kremers Jeffrey D. Thostenson Timothy S. Larson Mikel Prieto Michael B. Ishitani Sylvester Sterioff Mark D. Stegall 《American journal of transplantation》2003,3(6):715-721
We previously proposed a quantitative approach to assess donor organs for cadaver renal transplantation. To improve on our original scoring system, we studied 34 324 patients who received cadaver renal transplants from adult donors between 1994 and 1999 and were reported to the UNOS Scientific Renal Transplant Registry. A scoring system was developed from five donor variables (age, 0-25 points; history of hypertension, 0-4; creatinine clearance before procurement, 0-4; cause of death, 0-3; HLA mismatch, 0-3) that showed a significant correlation with renal function and long-term graft survival. Cadaver kidneys were stratified by cumulative donor score: grade A, 0-9 points; grade B, 10-19; grade C, 20-29; and grade D, 30-39. The influence of donor score on renal function and graft survival was most severe above 20 points, designated 'marginal' kidneys. In summary, a donor scoring system developed from a large population database was useful in predicting outcome after cadaver renal transplantation. The improved system provides a quantitative approach to evaluation of marginal kidneys and may improve allocation of these organs in cadaver renal transplantation. 相似文献
107.
Yasunori Cho Satoru Suzuki Masakazu Yokoi Muneaki Shimada Saburo Kuwabara Akira Murayama 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(10):476-479
Lymphoblastic lymphoma, an aggressive mediastinal mass, is recognized as serious threat to the patient in developing cardiac
tamponade or airway obstruction. Surgical procedure is often required to relieve clinical emergency and to establish prompt
pathological diagnosis. However, in such a patient, acute respiratory occlusion in the spine position can be a life-threatening
complication during general anesthesia. We describe a 17-year-old man whose cardiac tamponade was treated by pericardial-pleural
window through a left anterior thoracotomy in the lateral position. The patient recovered from hemodynamic compromise without
showing respiratory occlusion during general anesthesia and remained in the lateral position until extubation. Pathological
diagnosis was precursor T-lymphoblastic lymphoma. There were no complications attributable to the operative procedure. Further
chemotherapy reduced the mediastinal mass in size after two weeks when the patient developed sepsis and died. Lateral position
prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal
tumor with airway obstruction. 相似文献
108.
DeokBog Moon SungGyu Lee Shin Hwang KwangMin Park KiHun Kim ChulSoo Ahn YoungJoo Lee TaeYong Ha SeongHun Cho KiBong Oh YeonDae Kim KeonKuk Kim 《Liver transplantation》2004,10(6):802-806
We considered performing living donor liver transplantation (LDLT) in a larger-size recipient. When the recipient was large-sized, or when the donor liver was severely steatotic or had a right-to-left volume discrepancy. We devised dual living donor liver transplantation (DLDLT) to make up for graft size insufficiency and to secure the donor's safety. However, portal vein thrombosis (PVT) presented a challenge for DLDLT because of the need for intact right and left portal veins for the implantation of both liver grafts. Our 52-year-old male patient with hepatitis B cirrhosis had suffered from repeated esophageal and gastric variceal bleeding and underwent 2 trials of a transjugular intrahepatic portosystemic shunt (TIPS). He developed TIPS occlusion and PVT involving the area just above the spleno-mesenteric confluence to the right and left PV. Also, the right PV orifice was destructed and difficult to isolate because of severe periportal inflammation and neointima growth in the TIPS mesh. The patient's two sons were inadequate for donation because of right-to-left volume discrepancy. Therefore, DLDLT using 2 left lobes was necessary to compensate for graft-size insufficiency and to secure donor safety, and we substituted an intact umbilical portion of recipient's left PV for the destroyed right PV. The patient recovered well, and liver function has been normal for more than a year. In conclusion, the umbilical portion of recipient's left PV can be a useful vascular substitute for the reconstruction of a thrombosed main portal branch in DLDLT. 相似文献
109.
OBJECTIVE: The aim of the present study was to examine the nature of previously reported deficits in sustained attention and response inhibition in adults with the developmental disorder, phenylketonuria (PKU). METHODS: This study used event-related potentials (ERPs) to examine the performance of PKU adults (n=9) and a matched control group (n=9) on a visual Go-Nogo task. RESULTS: Comparison of behavioural measures between the PKU and control groups failed to reach statistical significance, yet analysis of the ERPs showed statistically significant amplitude reductions in the P1 and N1 components elicited following presentation of stimuli, and a reduction in the amplitude of the N2 component elicited following presentation of Nogo stimuli. CONCLUSIONS: These results suggest that adults with PKU, despite being continuously treated from birth, manifest subtle impairments in distinct aspects of information processing including early sensory processing of visually presented information, as well as impairments in inhibitory functions. SIGNIFICANCE: The results contribute to an understanding of the neurophysiological mechanisms that are implicated in PKU and highlight the sensitivity of ERP techniques for the identification of the loci of information processing deficits in clinical groups. 相似文献
110.
Joong-Yang Cho Jung Joon Sung Ju-Hong Min Kwang-Woo Lee 《Journal of clinical neuroscience》2006,13(9):908-912
Needle electromyography (EMG) and determining the motor evoked potential (MEP) of the genioglossus (tongue) are difficult to perform in evaluation of the craniobulbar region in patients with amyotrophic lateral sclerosis (ALS). Needle EMG and MEP determination in the upper trapezius were carried out in 17 consecutive ALS patients. The needle EMG parameters recorded included abnormal spontaneous activity and motor unit action potential morphology. An upper motor neuron lesion was presumed when either response to cortical stimulation was absent, or the central conduction time was delayed (>mean + 2 SD). Of the 12 patients with limb-onset ALS, using needle EMG, 11 were found to have abnormalities in the upper trapezius, and only five in the tongue. Three of the six patients with isolated limb involvement had abnormal MEP findings. In conclusion, electrophysiological studies of the upper trapezius are useful in ALS patients without bulbar symptoms. 相似文献