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  • 1
    ISSN: 1432-1238
    Keywords: Evaluation ; Scoring systems ; Inter-observer variability ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To explore translation, conversion and definition ambiguities, when using severity scoring systems in patients admitted to intensive care units (ICUs). Design A prospective study of the prognosis of acute renal failure in ICUs. Setting The study was conducted in 20 French ICUs. Patients 360 patients presenting with severe acute renal failure were studied during their ICU stay. Measurements and results The inter-observer variability of Apache II (acute physiology and chronic health evaluation), SAPS (simplified acute physiology score), and OSF (organ-system failure) was considered. For Apache II, we explored the uncertainty of measurements arising from conversion into SI units, the rounding procedures used for the non-inclusive intervals defined for quatitative parameters such as age, mean arterial pressure (MAP) or serum creatinite, the absence of definition of acute renal failure (ARF) and its consequence on doubling serum creatinine values, and the absence of guidelines in the case of spontaneous ventilation when arterial blood gases (ABG) and forced inspiratory oxygen (FIO2) were not measured. The resulting variability was evaluated, calculating the lowest and the highest value of the scoring system for each patient. The mean difference by patient was greater than 1.5 (p〈0.0001). Other examples were presented and discussed for SAPS and OSF. Conclusions Translation, conversion and definition ambiguities are a source of inter-observer variability and increase the risk of classification and/or selection biases. This gives rise to particular concern in the design and analysis of multicenter trials or meta-analysis, and improvement of these scoring systems should be envisaged in the future.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Intensive care ; Quality of life ; Nottingham Health Profile ; Perceived quality of life ; Professional status ; Long-term outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the quality of life of intensive care survivors 6 months after discharge. Design: Multicenter prospective study. Setting: Medical-surgical intensive care units (ICUs) of four French university hospitals. Patients: Among the 589 patients admitted to the four ICUs between 1 January and 31 March 1989, 329 were investigated. Measurements and results: A generic scale assessing health-related quality of life, the Nottingham Health Profile (NHP), a satisfaction scale, the Perceived Quality of Life scale (PQOL) and a questionnaire on professional status were sent by mail 6 months after discharge. Data concerning age, severity of acute illness (assessed by the Simplified Acute Physiology Score) and main diagnosis were recorded. A total of 223 questionnaires (67.8 %) were analysable. The professional status remained unchanged in 79.7 % of the patients, despite a significant (p 〈 0.01) increase (15.3 vs 22.1 %) in sick leave. Quality of life, assessed with NHP, was fair (50th percentile = 0.73 on a 0 to 1 scale), whereas satisfaction measured by PQOL was lower (50th percentile = 0.61). Both scales correlated well (z = 9.853; p = 0.0001) but with a large dispersion. The NHP scale showed a severe reduction in energy, sleep and emotional reactions, whereas social isolation, pain and physical handicap were infrequent. Family support was rated with the PQOL score as very good, whereas dissatisfaction concerning recreational and professional activities was expressed. Subsequent sick leave was associated with a poor quality of life (p 〈 0.05). Quality of life was mainly a function of the diagnosis, not of age and severity of illness: patients admitted for suicide attempt or chronic obstructive pulmonary disease fared poorly. Conclusions: Quality of life measured with a health-related quality of life scale and a satisfaction scale 6 months after an ICU stay depended on the admission diagnosis. Different dimensions of quality of life were variably affected.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1238
    Keywords: Intensive Care ; Outcome ; Evaluation studies ; Age ; Aged patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The influence of patient's age on survival, level of therapy and length of stay was analyzed from data collected in 792 consecutive admissions to eight intensive care units. Mortality rate increased progressively with age; over 65 years of age, it was more than double that of patients under 45 years (36.8% versus 14.8%). However, mortality rate in patients over 75 years was equal to that observed in the 55 to 59 years group. There was a significant relationship between age and acute physiology score (APS) and the influence of age upon outcome decreased when APS increased. The number of TISS (therapeutic intervention scoring system) points delivered to patients increased slightly but significantly with age (r=0.14). Standard care was responsible for the main part of this increase. Both in survivors and in non-survivors the length of stay was not different comparing the stay of the oldest patients with that of the younger age groups. We conclude that, in ICU patients, age is an important factor of prognosis but not as important as the severity of illness, and that there is no major difference in outcome of patients over 65 years of age compared to the entire study group of ICU patients.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 22 (1996), S. 833-834 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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