Abstract： Objective To evaluate prediction validation of Sino System for Coronary Operative Risk Evaluation （SinoSCORE） on in-hospital mortality in adult heart surgery patients in West China Hospital.?Methods?We included clinical records of 2 088 consecutive adult patients undergoing heart surgery in West China Hospital from January 2010 to May 2012, who were also included in Chinese Adult Cardiac Surgical Registry.We compared the difference of preoperative risk factors for the patients between Chinese Adult Cardiac Surgical Registry and West China Hospital. SinoSCORE was used to predict in-hospital mortality of each patient and to evaluate the discrimination and calibration of SinoSCORE for the patients.?Results?Among the 2 088 patients in West China Hospital, there were 168 patients （8.05%） undergoing coronary artery bypass grafting （CABG）, 1 884 patients （90.23%） undergoing heart valve surgery, and 36 patients （1.72%） undergoing other surgical procedures. There was statistical difference in the risk factors including hyperlipemia, stroke, cardiovascular surgery history, and kidney disease between the two units.The observed in-hospital mortality was 2.25% （47/2 088）. The predicted in-hospital mortality calculated by SinoSCORE was 2.35% （49/2 088） with 95% confidence interval 2.18 to 2.47. SinoSCORE was able to predict in-hospital mortality of the patients with good discrimination （Hosmer Lemeshow test: χ2=3.164, P=0.582） and calibration （area under the receiver operating characteristic curve of 0.751 with 95% confidence interval 0.719 to 0.924）. Conclusion SinoSCORE is an accurate predictor in predicting in-hospital mortality in adult heart surgery patients who are mainly from southwest China
Abstract: Objectives To evaluate the accuracy of four existing risk stratification models including the Society of Thoracic Surgeons(STS) 2008 Cardiac Surgery Risk Models for Coronary Artery Bypass Grafting (CABG), the European System for Cardiac Operative Risk Evaluation (EuroSCORE), the American College of Cardiology/American Heart Association (ACC/AHA) model, and the initial Parsonnet’s score in predicting early deaths of Chinese patients after CABG procedure. Methods We collected clinical records of 1 559 consecutive patients who had undergone isolated CABG in the Fu WaiHospital from November 2006 to December 2007. There were 264 females (16.93%) and 1 295 males (83.06%) with an average age of 60.87±9.06 years. Early death was defined as death inhospital or within 30 days after CABG. Calibration was assessed by the Hosmer-Lemeshow (H-L) test, and discrimination was assessed by the receiveroperatingcharacteristic (ROC) curve. The endpoint was early death. Results Sixteen patients(1.03%) died early after the operation. STS and ACC/AHA models had a good calibration in predicting the number of early deaths for the whole group(STS: 12.06 deaths, 95% confidence interval(CI) 5.28 to 18.85; ACC/[CM(159mm]AHA:20.67deaths, 95%CI 11.82 to 29.52 ), While EuroSCORE and Parsonnet models overestimated the number of early deaths for the whole group(EuroSCORE：36.44 deaths，95%CI 24.75 to 48.14；Parsonnet：43.87 deaths，95%CI 31.07 to 56.67). For the divided groups, STS model had a good calibration of prediction(χ2=11.46, Pgt;0.1)，while the other 3 models showed poor calibration（EuroSCORE：χ2=22.07，Plt;0.005；ACC/AHA：χ2=28.85，Plt;0.005；Parsonnet：χ2=26.74，Plt;0.005）.All the four models showed poor discrimination with area under the ROC curve lower than 0.8. Conclusion The STS model may be a potential appropriate choice for Chinese patients undergoing isolated CABG procedure.
Abstract: Objective To evaluate the prediction validation of European system for cardiac operative risk evaluation （EuroSCORE） in prolonged intensive care unit (ICU) stay, mortality, and major postoperative complications for Chinese patients operated for acquired heart valve disease. Methods Between January 2004 and January 2006, 2 218 consecutive patients treated for acquired heart valve diseases were enrolled in Fu Wai Hospital. All these patients accepted valvular surgery. Both logistic model and additive model were applied to EuroSCORE to evaluate its ability in predicting mortality, prolonged ICU stay and major postoperative complications of patients who had undergone heart valve surgery. An receiver operating characteristic curve（ ROC) area was used to test the discrimination of the models. Calibration was assessed by HosmerLemeshow goodnessoffit statistic. Results Discriminating abilities of logistic and additive EuroSCORE algorithm were 0.710 and 0.690 respectively for mortality, 0.670 and 0.660 for prolonged ICU stay, 0.650 and 0.640 for heart failure, 0.720 and 0.710 for respiratory failure, 0.700 and 0.740 for renal failure, and 0.540 and 0.550 for reexploration for bleeding. There was significant difference between logistic and additive algorithm in predicting renal failure and heart failure (Plt;0.05). Calibration of logistic and additive algorithm in predicting mortality, prolonged ICU stay and major postoperative complications were not satisfactory. However, logistic algorithm could be used to predict postoperative respiratory failure (P=0.120). Conclusion EuroSCORE is not an accurate predictor in predicting mortality, prolonged ICU stay and major postoperative complications, but the logistic model can be used to predict postoperative respiratory failure in Chinese patients operated for acquired heart valve diseases.
Objective To analyze the early clinical outcome of high-operative-risk coronary artery bypass grafting （CABG） classified according European System for Cardiac Operative Risk Evaluation （EuroSCORE）. Methods Classified eighty-four patients accepted CABG from Feb. 2004 to Sep. 2004 in our ward to high-operativerisk group （≥6, n=40） and low-medium-operative-risk group （0-5, n=44） according EuroSCORE. Record the operative schemes, complications after operation and evaluate the severe state with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment（SOFA） for all patients. Compare the early clinical outcome between the two groups. Results The operative mortality, ratio of long ICU-staying time, incidence of complications and severe degree of high-operative-risk group were higher than those in the low-mediumoperative-risk group. Standard EuroSCORE had significant positive correlation with either of A0, A1, Amax or S1, Smax counted in total patients （P〈0. 01）, and the same as logistic EuroSCORE （P〈 0. 05）. But when compared the relationships in certain risk ranks, only in high-operative-risk group the positive correlation was found between standard EuroSCORE and A1, Amax, S1 and Smax （P〈 0. 05）, between logistic EuroSCORE and Amax （P〈 0. 05）. Conclusion EuroSCORE could evaluate overall operative risk perfectly in our patients, and maybe more sensitively in the high-operative-risk patients. Many factors could improve the prognosis of high-operative-risk patients： accurate evaluation of the operative risk before surgery; perfect myocardial protection, effective myocardial revascularization and thorough correction of malformation in operation, and proper postoperative management in time.
Objective To comprehensively compare the methods and tools for medical risk management and assessment in the United Kingdom, the United States, Canada, Australia and Taiwan region (hereafter shortened as “four countries and one region”), so as to provide evidence and recommendations for medical risk management policy in China. Methods The official websites of the healthcare risk management agencies in these four countries and one region were searched to collect materials concerning healthcare risk management and monitoring, such as laws, regulatory documents, research reports, reviews and evaluation forms, then the descriptive comparative analysis was performed on the methods and tools for risk management. Results a) A total of 146 documents were included in this study, including 2 laws, 17 regulatory documents, 41 guidelines, 37 reviews and 49 documents about general information; b) The United Kingdom applied the integrated risk management; Australia and Taiwan adopted the classical risk management process, including risk identification, risk analysis, risk evaluation and risk control, while the United States and Canada mainly chose the prospective failure mode and effects analysis (FMEA) for clinical risk management; c) The severity of clinical risk was divided into five grades in the United Kingdom and Australia, and six in Taiwan, respectively. The frequency of medical risk was divided into five grades with four grade responses in above two countries and one region; and d) There were almost the same processes and tools about Root Cause Analysis (RCA), but a little difference in the objects of analysis in these four countries and one region. Conclusion?There are three models of risk management with the same assessment tools in these four countries and one region: the prospective risk assessment, the retrospective assessment based on occurred incidents and the integrated risk management. Although the grading of risk is similar, the definition of grading is different in the United Kingdom, Australia and Taiwan. The methods and processes of analyses on the adverse events are almost the same in these four countries and one region.
目的 总结风险评估和预警措施在中毒患者洗胃救治中的作用，以减少洗胃并发症发生，保证救治安全。方法 抽取2009年1月－2010年12月在急诊科实施强制洗胃患者90例，2009年中毒洗胃患者45例为对照组，2010年中毒洗胃患者45例为观察组。对照组实施常规护理，观察组在常规护理的基础上实施风险评估，比较两组患者洗胃并发症发生情况。结果 观察组洗胃并发症较对照组明显减少，两组比较差异有统计学意义（χ2=10.601，P＜0.01）。结论 风险评估可提高护理人员对洗胃风险的预见性，有效减少并发症的发生。
目的 探讨围手术期患者静脉血栓预防的分级护理方法，为静脉血栓的预防提供实证依据。 方法 2009年5月－2012年1月，以某市级乙等综合性医院各科室手术患者为对象，引入量化工具评估患者围手术期静脉血栓发生的危险，并根据评估结果采取分级护理方法进行防治，并在患者出院时用彩色多普勒超声判断是否存在静脉血栓，以验证分级护理防治效果。 结果 纳入的318患者经评估均存在发生静脉血栓的风险，其中低度危险患者65例，中度182例，高度危险71例。经分级护理治疗，出院时均未发生静脉血栓症状、肺栓塞。 结论 分级护理方法安全、简便，可操作性强，便于围手术期患者静脉血栓的早期、普遍预防，值得推广。
Objective To validate the accuracy of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM), and to find out the relationship between clinical risk factors and the predictive value produced by ACPGBI-CCM. Methods The patients diagnosed definitely as colorectal cancer in the department of anal-colorectal surgery, West China hospital from April 2007 to July 2007 were analyzed retrospectively. And the predictive value of mortality for each patient was calculated by ACPGBI-CCM, then the difference of risk factors was compared by classifying the patients into lower risk group and higher risk group by making the median predictive mortality as a cut point. Results From April 2007 to July 2007, a total of 99 patients diagnosed definitely as colorectal cancer accepted treatment, and among which 67 patients included in this study were admitted whose average age was 60.09 years. And there were 34 male and 33 female patients; 15 right hemicolon cancer, 9 left hemicolon cancer, 43 rectal cancer; Dukes staging: A 0 case, B 37 cases, C 24 cases, D 6 cases. The observed mortality 30 days after operation was 0, whereas the predictive mortality was 0.77%-25.75% with a median value of 3.36%. Then the patients whose predictive mortality were ≤3.36% were grouped as lower risk group (34 cases), the others higher risk group (33 cases), and there was strikingly different predictive mortality between two groups 〔(8.86±4.51)% vs (1.76±0.68)%, P＜0.01〕. And between two groups, the age, internal medicine complications, preoperative chemotherapy, ASA grading, cancer resected, and operative time made predominant differences (P＜0.01); and the neoplastic complications, Dukes staging, TNM classification, postoperative pain showed differences, too (P＜0.05); however, the gender, history of abdominal operation, the distance of the neoplasm to anal edge, the cancer location, differentiated degree, postoperative hospitalization time, and total hospitalization time didn’t have any differences (Pgt;0.05). Furthermore, stratification analysis was made for risk factors, and it came out that there were great differences of predictive mortality for different age groups and ASA grading, having internal medicine complications or not, having chemotherapy or not, and for cancer resected or not, and the differences were statistically significant (P＜0.01); also different Dukes staging or differentiation could cause different mortality (P＜0.05); but the difference of mortality didn’t make any sense according to gender, having abdominal operative history or not, having neoplastic complications or not, different TNM staging and cancer location (Pgt;0.05). Conclusion The clinical applicability of the ACPGBI-CCM is ascertained in such a large volume single medical centre, but the ACPGBI-CCM overpredicts the mortality in this study which may be attributed to the different areas, nations, or the different cultures. The complications and the neo-adjuvant or adjuvant therapy are further found out that they may be independent predictive factors of survival, and more research will be needed to prove this.
Objective To evaluate the risk of management decision combined neo-adjuvant chemotherapy with operation for colorectal cancer by means of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM). Methods One hundred and eighty-one eligible patients (102 male, 79 female, mean age 58.78 years), which were pathologically proved colorectal cancer in our ward from July to November 2007, involved 62 colonic and 119 rectal cancer. The enrollment were assigned into multi-disciplinary team (MDT) group (n=65) or non-MDT group (n=116), according to whether the MDT was adopted, and the operative risk was analyzed by ACPGBI-CCM. Results The baseline characteristics of MDT and non-MDT group were coherent. The watershed of lower risk group (LRG) and higher risk group (HRG) was set as predictive mortality=2.07%. The time involving extraction of gastric, urethral and drainage tube, feeding, out-of-bed activity after operation in MDT group, whatever in LRG or HRG, were statistically earlier than those in non-MDT group (P＜0.05). The resectable rate in LRG was statistically higher than that in HRG (P＜0.05), and the proportion of Dukes staging was significantly different (P＜0.05) between two groups; Moreover, predictive mortality in HRG was statistically higher than that in LRG (P＜0.05), while actually there was no death in both groups. Conclusion Dukes staging which is included as an indispensable option by ACPGBI-CCM is responsible for the lower predictive mortality in LRG.Hence, the value of ACPGBI-CCM used to asses the morbidity of complications within 30 days postoperatively would be warranted by further research. The postoperative risk evaluation can serve as a novel routine to comprehensively analyze the short-term safe in the MDT.
ObjectiveTo establish the model of nosocomial infection risk assessment, and evaluate its accuracy of prediction. MethodsThe model of nosocomial infection risk assessment was established by expert grading, and cross-section survey of nosocomial infection was used to evaluate the predictive effect from December 2013 to February 2014. ResultsThe infection risk score of the model had statistically significant influence on nosocomial infection [OR=1.35, 95%CI (1.26, 1.44), P<0.001]. The area under curve of the receiver operating characteristic curve was 0.754. The diagnostic test's sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 56.30%, 84.50%, 17.80%, 97.00% and 82.95% respectively, and the cutoff was 4. ConclusionThe model of nosocomial infection risk assessment has certain significance in the prediction of nosocomial infection, and can be regarded as a reference for establishing precaution system of nosocomial infection.