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Journals / Ulusal Travma ve Acil Cerrahi Dergisi / 2009 / Cilt: 15 - Sayı: 5

Sistemik travma geçirmiş kafa travmalı olguların mortalite tahmininde ‘Düzeltilmiş Akut Fizyoloji ve Kronik Sağlık Değerlendirme Sistemi’ (APACHE II), Glasgow Koma Skorundan daha üstündür

The revised Acute Physiology and Chronic Health Evaluation System (APACHE II) is more effective than the Glasgow Coma Scale for prediction of mortality in head-injured patients with systemic trauma

Adil DALGIÇ
Fikret M. ERGÜNGÖR
Türker BECAN
Atila ELHAN
Önder OKAY
Bülent C. YÜKSEL
Pages
453–458
DOI
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⚡ TL;DR(Too Long; Didn't Read)

CONCLUSION For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.

📌 3 Key Takeaways

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Objective & Hypothesis:BACKGROUND The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients.
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Key Findings & Data:The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS.
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Conclusion & Impact:CONCLUSION For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.
🔬Design:Research Article
📍Scope:2003 Verileri
⚙️Variables:Kranioserebral travma · Glasgow koma skalası · ROC eğrisi

Abstract

BACKGROUND The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. Nevertheless, the necessity of using a more complex system than GCS has been questioned recently. The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS. In addition, it is thought to be superior to GCS due to recognition of increasing age and significant chronic health problems, which adversely affect mortality. METHODS This retrospective study included 266 patients (195 males, 71 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2003 and 2004. RESULTS Mortality increased in the elderly group (p<0.001). Mean survival score in APACHE II was 38.0 and death score was 68.7 (p<0.001); these values in GCS were 10.4 and 6.3, respectively (p<0.001). APACHE II at the cut-off point was better than GCS in the prediction of death and survival in patients (p<0.01). The area under the receiver operating characteristic curve for sensitivity and specificity was larger in APACHE II (0.892±0.028) than GCS (0.862±0.029). CONCLUSION For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.

Özet

AMAÇ Glasgow Koma Skoru (GKS) yaygın, basit, güvenli ve travma hastalarının bilinç değerlendirilmesinde iyi bir iletişim skalasıdır. Ancak, son yıllarda GKS’den daha ayrıntılı bir sistem gerekliliği sorgulanmaktadır. Düzeltilmiş akut fizyoloji ve kronik sağlık değerlendirilmesi sistemi (APACHE II) GKS ile birlikte 12 fizyolojik parametre içeren fizyolojik temelli bir skaladır. Ayrıca mortaliteyi etkileyen kronik hastalık ve ileri yaş değişkenlerini de içermesi GKS’den daha üstün olduğunu düşündürmektedir. GEREÇ VE YÖNTEM Bu çalışmada, 2003 ve 2004 yıllarında kafa travması ile birlikte sistemik travma geçirmiş 266 olgu (195 erkek,71 kadın; ort. yaş 60,5; dağılım 14-87) geriye dönük olarak değerlendirildi. BULGULAR Mortalite ileri yaş grubunda artmıştı (p<0,001). Ortalama APACHE II skoru yaşayanlarda 38,0, ölen olgularda 68,7 (p<0,001), ortalama GKS puanı yaşayanlarda 10.4 ölen olgularda 6,3 (p<0,001) bulundu. Mortalite tahmininde APACHE II GKS’den daha belirgin sınır puanı sağladı (p<0,001). Duyarlılık ve özgünlük için yapılan ROC eğrisinde, APACHE II (0,892±0,028) eğrisi altında kalan alan GKS’den daha büyüktü (0,862±0,029). SONUÇ Mortalite değerlendirmesinde, özellikle acil servislerde GKS kafa travmalı olgularda yeterli öngörü sağlayan, basit ve kolay uygulanmakla birlikte sistemik travma geçirmiş olgularda APACHE II hastanın önemli fizyolojik parametrelerini de içermesi nedeniyle GKS’den üstündür.

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Cite This Article

DALGIÇ, A., ERGÜNGÖR, F. M., BECAN, T., ELHAN, A., OKAY, Ö., YÜKSEL, B. C. (2009). Sistemik travma geçirmiş kafa travmalı olguların mortalite tahmininde ‘Düzeltilmiş Akut Fizyoloji ve Kronik Sağlık Değerlendirme Sistemi’ (APACHE II), Glasgow Koma Skorundan daha üstündür. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 15 - Sayı: 5, 453–458. https://ajindex.com/articles/324351

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