BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness(FOUR) score and Glasgow Coma Scale(GCS) as predictors of outcome in children with impaired consciousness.METHODS: In this obser...BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness(FOUR) score and Glasgow Coma Scale(GCS) as predictors of outcome in children with impaired consciousness.METHODS: In this observational study, children(5–12 years) with impaired consciousness of <7 days were included. Children with traumatic brain injury, on sedatives or neuromuscular blockade; with pre-existing cerebral palsy, mental retardation, degenerative brain disease, vision/hearing impairment; and seizure within last 1 hour were excluded. Primary outcomes: comparison of area under curve(AUC) of receiver operating characteristic(ROC) curve for in-hospital mortality. Secondary outcomes: comparison of AUC of ROC curve for mortality and poor outcome on Pediatric Overall Performance Category Scale at 3 months.RESULTS: Of the 63 children, 20 died during hospital stay. AUC for in-hospital mortality for GCS was 0.83(CI 0.7 to 0.9) and FOUR score was 0.8(CI 0.7 to 0.9) [difference between areas –0.0250(95%CI 0.0192 to 0.0692), Z statistic 1.109, P=0.2674]. AUC for mortality at 3 months for GCS was 0.78(CI 0.67 to 0.90) and FOUR score was 0.74(CI 0.62 to 0.87)(P=0.1102) and AUC for poor functional outcome for GCS was 0.82(CI 0.72 to 0.93) and FOUR score was 0.79(CI 0.68 to 0.9)(P=0.2377), which were also comparable. Inter-rater reliability for GCS was 0.96 and for FOUR score 0.98.CONCLUSION: FOUR score was as good as GCS in prediction of in-hospital and 3-month mortality and functional outcome at 3 months. FOUR score had a good inter-rater reliability.展开更多
Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology ...Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II sco展开更多
目的本试验评价了雷米芬太尼用于开颅手术后患者镇静镇痛治疗的安全性和有效性。方法将44例开颅手术后,定向力恢复、无需人工气道、生命体征平稳的患者,随机分为试验组和对照组。试验组患者使用雷米芬太尼输注,若输注速度达到6μg/kg而...目的本试验评价了雷米芬太尼用于开颅手术后患者镇静镇痛治疗的安全性和有效性。方法将44例开颅手术后,定向力恢复、无需人工气道、生命体征平稳的患者,随机分为试验组和对照组。试验组患者使用雷米芬太尼输注,若输注速度达到6μg/kg而未达到治疗目标(SAS=1-3;PI=1-2),则开始异丙酚靶控输注。对照组患者在靶控输注异丙酚前,给予芬太尼25μg至PI≤3。输注过程中监测并记录SAS,PI,MAP,HR,SPO2及RR。当RR低于13次/min时,检查动脉血气并记录PCO2。记录所有不良反应及患者不适。结果两组患者均达到理想的镇痛镇静深度(SAS=3-4,PI=1-2),试验组患者均未使用异丙酚。两组患者达到满意镇静镇痛深度后,MAP较给药前明显下降。试验组患者RR和PI的下降较对照组明显(RR,13.52±2.29vs18.14±1.86,P=0.006;PI,1.00±0.07 vs 1.61±0.49,P=0.001)。两组患者不良反应的发生率均较低,且不严重,两组间无差异(P=0.587)。结论雷米芬太尼可以安全有效地应用于开颅手术后清醒、无人工气道且生命体征平稳的患者。展开更多
文摘BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness(FOUR) score and Glasgow Coma Scale(GCS) as predictors of outcome in children with impaired consciousness.METHODS: In this observational study, children(5–12 years) with impaired consciousness of <7 days were included. Children with traumatic brain injury, on sedatives or neuromuscular blockade; with pre-existing cerebral palsy, mental retardation, degenerative brain disease, vision/hearing impairment; and seizure within last 1 hour were excluded. Primary outcomes: comparison of area under curve(AUC) of receiver operating characteristic(ROC) curve for in-hospital mortality. Secondary outcomes: comparison of AUC of ROC curve for mortality and poor outcome on Pediatric Overall Performance Category Scale at 3 months.RESULTS: Of the 63 children, 20 died during hospital stay. AUC for in-hospital mortality for GCS was 0.83(CI 0.7 to 0.9) and FOUR score was 0.8(CI 0.7 to 0.9) [difference between areas –0.0250(95%CI 0.0192 to 0.0692), Z statistic 1.109, P=0.2674]. AUC for mortality at 3 months for GCS was 0.78(CI 0.67 to 0.90) and FOUR score was 0.74(CI 0.62 to 0.87)(P=0.1102) and AUC for poor functional outcome for GCS was 0.82(CI 0.72 to 0.93) and FOUR score was 0.79(CI 0.68 to 0.9)(P=0.2377), which were also comparable. Inter-rater reliability for GCS was 0.96 and for FOUR score 0.98.CONCLUSION: FOUR score was as good as GCS in prediction of in-hospital and 3-month mortality and functional outcome at 3 months. FOUR score had a good inter-rater reliability.
文摘Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II sco
文摘目的本试验评价了雷米芬太尼用于开颅手术后患者镇静镇痛治疗的安全性和有效性。方法将44例开颅手术后,定向力恢复、无需人工气道、生命体征平稳的患者,随机分为试验组和对照组。试验组患者使用雷米芬太尼输注,若输注速度达到6μg/kg而未达到治疗目标(SAS=1-3;PI=1-2),则开始异丙酚靶控输注。对照组患者在靶控输注异丙酚前,给予芬太尼25μg至PI≤3。输注过程中监测并记录SAS,PI,MAP,HR,SPO2及RR。当RR低于13次/min时,检查动脉血气并记录PCO2。记录所有不良反应及患者不适。结果两组患者均达到理想的镇痛镇静深度(SAS=3-4,PI=1-2),试验组患者均未使用异丙酚。两组患者达到满意镇静镇痛深度后,MAP较给药前明显下降。试验组患者RR和PI的下降较对照组明显(RR,13.52±2.29vs18.14±1.86,P=0.006;PI,1.00±0.07 vs 1.61±0.49,P=0.001)。两组患者不良反应的发生率均较低,且不严重,两组间无差异(P=0.587)。结论雷米芬太尼可以安全有效地应用于开颅手术后清醒、无人工气道且生命体征平稳的患者。
