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31.
Sander P. G. Frankema Michael J. R. Edwards Ewout W. Steyerberg Arie B. van Vugt 《European Journal of Trauma》2002,28(6):355-364
Background: Evaluating the performance of a trauma system may be attempted by comparing outcome in different trauma populations. Controlling
for injury severity is a necessity for such evaluations. We compare two current models for doing so: the “Trauma and Injury
Severity Score” (TRISS) and “A Severity Characterization Of Trauma” (ASCOT).
Material and Methods: This study of high-energy trauma victims took place in Leiden, the Netherlands, between 1993 and 1998. Using the Hosmer-Lemeshow
(HL) test and receiver operator characteristic (ROC) analysis, the TRISS and ASCOT models were compared for calibration and
discrimination.
Results: 1,024 patients, with an average Injury Severity Score (ISS) of 13.5, were eligible for inclusion. Blunt trauma was the predominant
cause of injuries. Both models gave accurate, though pessimistic, results in predicting the actual number of fatalities (n
= 71). The HL test indicated a sufficient fit for the ASCOT model (p = 0.28) and an insufficient fit (p = 0.02) for TRISS.
The ROC curves were nearly identical (0.97). Including age as a linear variable, instead of using the current age groups,
resulted in an improved discriminative power of the models.
Conclusions: The ASCOT model proved superior over TRISS in its accuracy to estimate of survival chances. This difference was most evident
for victims with an estimated survival chance of 60–90%. Future national trauma researchers should therefore collect ASCOT
data. Improved ASCOT models could be developed, with age as a linear variable.
Received: April 25, 2002; revision accepted: September 17, 2002
Correspondence Address Prof. Arie B. van Vugt, MD, PhD, Department of General Surgery and Traumatology, Erasmus MC Rotterdam, Dr. Molewaterplein
40, Postbus 2040, 3000 CA Rotterdam, The Netherlands, Phone (+31/10) 463-5735, Fax -4757, e-mail: vanvugt@hlkd.azr.nl 相似文献
32.
Mortality Rates and Predictors of Mortality Among Late-Middle-Aged and Older Substance Abuse Patients 总被引:2,自引:0,他引:2
Rudolf H. Moos Penny L. Brennan Jennifer R. Mertens 《Alcoholism, clinical and experimental research》1994,18(1):187-195
This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients ( n = 21, 139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems. 相似文献
33.
100例严重烧伤死亡病例分析 总被引:1,自引:0,他引:1
目的 通过对两阶段烧伤死亡病人基本情况进行对比分析,以期探讨进一步提高烧伤救治率的有效措施。方法 总结近20年死亡烧伤病人100例,按前后各10年各50例病人分组(A和B两组),对其病死率,烧伤面积,深度,致伤原因,院前治疗情况,入院时间,存活时间,吸入伤,气管切开,呼吸机与纤支镜的应用,手术例次,血液透析及死亡原因等进行对比分析。结果 两组烧伤严重程度无差别。致伤原因(多为火焰,爆炸和热液)和死亡原因(严重全身感染,多脏器衰竭和吸入性损伤)也类似,而近10年烧伤病死率明显降低,而入院时间明显滞后,但病人入院后存活时间明显延长,进一步分析发现近10年气管切开和呼吸机应用更加积极和应用广泛,纤支镜辅助检查和治疗增多,手术积极并例次增多,血液透析病例增多。结论 近lO年积极的气管切开,呼吸机和血液透析的应用和积极的手术治疗等综合治疗措施的改进对延长严重烧伤病人的存活期起着重要作用。 相似文献
34.
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
35.
烧伤患者吸入性损伤和肺部感染的发生特点及其对死亡的影响 总被引:3,自引:0,他引:3
为了评价吸入性损伤和肺部感染的发生特点及其对死亡的影响,总结了我科近14年住院治疗的热力烧伤患者940例,其中吸入性损伤75例,轻度15例,全部治愈,中度25例,死亡13例,死亡率为52.0%,重度35例,死亡31例,死亡率为88.6%。统计分析表明,合并吸入性损伤者69.3%在密闭空间发生,同时伴有面部烧伤者达96.0%。随着烧伤面积的增加,吸入性损伤发生率和肺部感染的发生率相应增加。有吸入性损伤肺部感染较无吸入性损伤肺部感染率为高(P<0.01),发生时间早。两组同等烧伤面积、深度、年龄患者,有吸入性损伤组发生死亡的危险比无吸入性损伤组大17.2倍(P<0.001)。烧伤面积、深度和年龄相近,合并肺部感染者明显增加了死亡的机会(P<0.001)。 相似文献
36.
努力提高严重多发伤的基础研究和临床救治水平 总被引:1,自引:0,他引:1
目的:探讨提高严重多发伤的基础研究和临床救治水平。方法:结合我们的有关研究和参加抢救的临床救治体会,并引用国内外公开发表的相关论文及著作进行分析研究。结果:善于应用现有的先进科技手段,提高严重多发伤的基础研究和临床救治水平。降低伤残率和死亡率。结论:严重多发伤具有脏器损伤率高、出血性休克率高、感染率高、MODS发生率高、死亡率高等“五高”特点,所以其诊治的复杂性、紧迫性远远超过其他许多疾病。因此努力提高我国严重多发伤的基础研究及诊断和救治水平已是当务之急。 相似文献
37.
Kazumasa Fujitani Jaffer A. Ajani Christopher H. Crane Barry W. Feig Peter W. Pisters Nora Janjan Garrett L. Walsh Stephen G. Swisher Ara A. Vaporciyan David Rice Angela Welch Jackie Baker Josephine Faust Paul F. Mansfield MD 《Annals of surgical oncology》2007,14(4):1305-1311
Background Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction
chemotherapy and preoperative chemoradiotherapy (CTX–CTXRT). However, the influence of CTX–CTXRT on operative morbidity and
mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and
mortality after surgery combined with CTX–CTXRT, and identify factors predictive of postoperative complications in patients
with localized gastric or gastroesophageal adenocarcinoma.
Methods A prospectively collected database on 71 consecutive patients who underwent CTX–CTXRT at M.D. Anderson Cancer Center between
January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall
complications were identified by multivariate logistic regression analysis.
Results Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years
[relative risk 11.3 (95% confidence interval 2.50–50.6)] and body mass index (BMI) of 26 kg/m2 or above [relative risk 4.08 (95% confidence interval 1.08–15.4)] were significant risk factors for overall complications.
Conclusions CTX–CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with
gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity. 相似文献
38.
F. D’Angelo M. Giudici M. Molina G. Margaria 《Journal of orthopaedics and traumatology》2005,6(3):111-116
Abstract
The femoral neck fracture is actually the most important traumatic event in the elderly, because of its high rate and terrible
complications. We reviwed clinical records of 314 patients treated in our institution with a bipolar implant for femoral neck
fracture. At a mean follow-up of 5 years, 15 patients (4.8%) were lost to followup so data for 299 patients was studied to
identity factors associated with mortality. Ten predictor variables were examined: age, sex, waiting time for surgery, pulmonary
dysfunction, fracture etiology, and comorbidity with ischemic heart disease, and heart failure, hypertension, cerebrovascular
disease, and chronic renal failure. Cumulative mortality rate during the first 6 months was 19% (55 of 299 patients) and in
the first year it was 25% (76 of 299). At logistic regression analysis, mortality was associated with age, male gender, waiting
period for surgery and presence of neoplastic disease or pathological fracture.
Waiting for surgery was a significant factor for mortality at 6, 12 and 24 months: patients surgically treated in the first
24 hours had lower mortality than those who waited longer. The risk of mortality in the first 6 months doubled for an age
increase of 12 years, while mortality within 2 years doubled for an age increase of 9 years. Although the motality rate after
surgery for femoral neck fracture was high in the first year (25%), it dropped off in successive years to levels observed
in a healthy population. Thus, we agree with the literature that femoral fracture is a risk factor for survival only in the
first year after trauma, above all in the elderly. 相似文献
39.
Mahmut Koç Ömer Yoldaş Yusuf Alper Kılıç Erdal Göçmen Tamer Ertan Hayrettin Dizen Mesut Tez 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(5):581-585
Background and aims The aim of this study is to evaluate the predictive accuracy of different scoring systems on surgery for perforated peptic
ulcer referred to an academic department of general surgery in a tertiary reference center.
Patients and methods Seventy-five consecutive patients (Male/female ratio = 64:11; mean age, 44 years; range, 16–85) with perforated peptic ulcer
disease were investigated. Disease severity scores and mortality predictions were calculated using the collected data during
admission. Discrimination and calibration characteristics of each system, namely, the acute physiology and chronic health
evaluation II and III, the simplified acute physiology score II, and the mortality probability models (MPM) II, were determined
by using the area under receiver operating characteristics curve and the Hosmer–Lemeshow goodness-of-fit test, respectively.
Results Among the 75 patients included, there were eight (10.6%) mortalities. All systems had a reliable power of discrimination and
calibration. Among the systems tested, MPM II was the best performing as far as discrimination and calibration characteristics
were considered. The parameters of MPM II system that were related to systemic perfusion of the patient were significantly
positive in patients who died compared to those who survived.
Conclusions MPM II that predicted mortality at admission is better than the other systems in predicting mortality. Results also indicate
the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation. 相似文献
40.
Background: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To
evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment.
Methods: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995.
The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy.
Results: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were
successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications
and 7.4% had reoperations.
Conclusions: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances
a definitive treatment can be carried out without conversion and has the additional and well-known advantages of minimally
invasive surgery.
Received: 15 March 1996/Accepted: 29 August 1996 相似文献