Should the pre-sedation Glasgow Coma Scale value be used when calculating Acute Physiology and Chronic Health Evaluation scores for sedated patients?

摘要: Objective: To assess the effect on performance of Acute Physiology and Chronic Health Evaluation (APACHE) II APACHE III two different approaches to scoring Glasgow Coma Scale (GCS) in sedated patients. The first approach was assume that GCS score normal, second use value recorded before patient sedated. Design: Prospective cohort study over 2 yrs. Setting: Twenty-two general adult intensive care units Scotland. Patients: 13,291 consecutive admissions participating units. Measurements Main Results: After exclusion patients according standard, predefined criteria, systems were used calculate probability hospital mortality for included study. In whose scores could not be assessed accurately during 24 hrs, predictions calculated twice: first, assuming normal; second, substituting sedation. This generated databases each system, both compared with observed rate. using measures discrimination (area under receiver operating characteristic curve) goodness fit (calibration curves Hosmer-Lemeshow statistic). Analysis undertaken entire group altered. There a wide variation number who had their altered between also differences diagnostic groups. Overall, however, 50% 22% Using presedation increased III. calibration improved but deteriorated. improved, those scores, suggesting overall deterioration is attributable other limitations model these data. Although changes greatest neurologic or trauma diagnosis, important most Conclusions: an component It should directly whenever possible. When are sedated, sedation preferable assumption normality. variations groups highlight possible effects case mix prognostic systems.