不同评分者急性生理和慢性健康评分的差异及其原因分析

Score of Acute Physiology and Chronic Health from Different Raters and Causes of the Differences

目的:了解急性生理和慢性健康状况评分(APACHEII)的差异及其原因。方法:对2名医生做的32例重症患者的APACHEII评分进行前瞻性分析,讨论各项生理数值和评分的一致性,及导致不一致的原因。结果:两名医生APACHE II评分的一致性较差(Kapp=0.695),其中慢性健康评分(Kappa=0.75)和年龄评分(Kappa=0.956)的一致性较好,而急性生理评分(APS)的一致性差(Kappa=0.728)。APS的各项指标中,两名医生记录的原始数据共有160处不同,最终造成52处生理评分的不同。其比例最高有3项,第一为血清钾(8/11)第二为AaDO2(9/20),第三为平均动脉压(11/25)。造成评分差异的最主要原因为生理指标不同(85.2%),另有数据一致时评分不同的共9处,其中8处是由于评分者未遵循氧合评分标准,另1处为取值不同造成。结论:为了进一步提高评分的准确性,我们应该强化评分准则和积极做专业评分培训。

Objective： Objective： To investigate the differences of the scores from different raters in taking the Acute Physiology and Chronic Health Evaluation（APACHEII） and the causes of the difference.Methods： Two doctors got the APACHE II scores from the same 32 cases of severe patients.The consistency of the data and scores of each indicator were prospectively analyzed and the causes of the inconsistence were discussed.Results： The consistency of APACHE II score from two doctors was low（Kapp = 0.695）.The consistency of chronic health score（Kappa = 0.75） and age score（Kappa = 0.956） were better,but they were of poor agreement（Kappa = 0.728） in terms of acute physiology score（APS）.From the indicators of APS,the two doctors recorded a total of 160 different raw data,and eventually got 52 different physiological scores.The highest proportion of three items,were first for the serum potassium（8 / 11）,second for AaDO2（9 / 20）,and third for the mean arterial pressure（11/25）.The main reason causing the difference scores was the differences of physiological indicators（85.2%）.Nine differences in scores were found when taking the same data,of which eight were caused by not following oxygenation rate score,and the other one is caused by different values.Conclusion： In order to further improve the accuracy of scores,it is necessary to strengthen the assessment criteria and do professional training positively.