Predicting Mortality Following Traumatic Brain Injury or Subarachnoid Hemorrhage: An Analysis of the Validity of Standardized Mortality Ratios Obtained From the APACHE II and ICNARC H-2018 Models.

IF 2.3 2区医学 Q2 ANESTHESIOLOGY Journal of neurosurgical anesthesiology Pub Date : 2023-07-01 DOI:10.1097/ANA.0000000000000831

Matt Rowe, Jules Brown, Aidan Marsh, Julian Thompson

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引用次数: 2

Abstract

Introduction: Standardized mortality ratios (SMRs), calculated using the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) and Intensive Care National Audit and Research Centre H-2018 (ICNARC H-2018 ) risk prediction models, are widely used in UK intensive care units (ICUs) to measure and compare the quality of critical care delivery. Both models incorporate an assumption of Glasgow Coma Score (GCS) if an actual GCS without sedation is not recordable in the first 24 hours after ICU admission. This study assesses the validity of the APACHE II and ICNARC H-2018 models to predict mortality in ICU patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (aSAH) in whom GCS is related to outcomes.

Methods: In a retrospective analysis, the SMR calculated by the APACHE II and ICNARC H-2018 models for all UK ICU admissions in a 1-year period was compared with calculated SMRs in TBI/aSAH patients and at 3 GCS groups. Data for patients admitted to a single tertiary neurocritical care unit were similarly analyzed.

Results: Both models predicted mortality well for the overall TBI/aSAH population; SMR (95% confidence interval) was 1.00 (0.96-1.04) and 0.99 (0.95-1.03) for the APACHE II and ICNARC H-2018 models, respectively. When analyzed by GCS grouping, both models underpredicted mortality in TBI/aSAH patients with GCS ≤8 (SMR, 1.1 [1.05-1.15]) and "unrecordable" GCS (SMR, 1.88 [1.77-1.99]). Similar findings were identified in the local data analysis.

Discussion: The APACHE II and ICNARC H-2018 models predicted mortality well for the overall TBI/aSAH ICU population but underpredicted mortality when GCS was ≤8 or "unrecordable." This raises questions about the accuracy of these risk prediction models in TBI/aSAH patients and their use to evaluate treatments and compare outcomes between centers.

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预测创伤性脑损伤或蛛网膜下腔出血后的死亡率:从APACHE II和ICNARC H-2018模型中获得的标准化死亡率的有效性分析

使用急性生理、年龄、慢性健康评估II (APACHE II)和重症监护国家审计和研究中心H-2018 (ICNARC H-2018)风险预测模型计算的标准化死亡率(SMRs)广泛用于英国重症监护病房(ICUs)，以衡量和比较重症监护服务的质量。如果在ICU入院后的最初24小时内没有记录实际的GCS，则两种模型都纳入了格拉斯哥昏迷评分(GCS)的假设。本研究评估了APACHE II和ICNARC H-2018模型预测创伤性脑损伤(TBI)或动脉瘤性蛛网膜下腔出血(aSAH) ICU患者死亡率的有效性，其中GCS与预后相关。方法:在一项回顾性分析中，将APACHE II和ICNARC H-2018模型计算的1年内所有英国ICU入院患者的SMR与TBI/aSAH患者和3个GCS组的计算SMR进行比较。在单一三级神经重症监护病房住院的患者数据也进行了类似的分析。结果:两种模型都能很好地预测TBI/aSAH总体人群的死亡率;APACHE II和ICNARC H-2018型号的SMR(95%置信区间)分别为1.00(0.96-1.04)和0.99(0.95-1.03)。通过GCS分组分析，两种模型均低估了GCS≤8 (SMR, 1.1[1.05-1.15])和“不可记录”GCS (SMR, 1.88[1.77-1.99])的TBI/aSAH患者的死亡率。在当地数据分析中也发现了类似的发现。讨论:APACHE II和ICNARC H-2018模型对TBI/aSAH ICU总体人群的死亡率预测良好，但当GCS≤8或“不可记录”时，对死亡率的预测不足。这就提出了这些风险预测模型在TBI/aSAH患者中的准确性及其用于评估治疗和比较中心之间结果的问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.