預測高血糖危症死亡機率的刻度表：以 Rasch 分析來驗證
A Screening Tool used on Hyperglycemic Crises Death (HCD) Scale
許建清 1、黃建程 1,2、林宏榮 1、錢才瑋 3、郭浩然 2、蘇世斌 2,4
奇美醫學中心急診部 1、國立成功大學環境醫學研究所 2、奇美醫學中心企劃管理部 3、
奇美醫學中心家庭醫學科 4
Background: Hyperglycemic crises present a disease continuum of diabetic emergency
consisting of three subgroups: diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic
state (HHS), and mixed DKA/HHS. The mortality, incidence and the cost of treating
hyperglycemic crises is high and continues to rise. Based on the balance of patient safety, cost,
and medical resources, two questions are raised: [1] What is the mortality risk? and [2] What
is the most appropriate disposition after Emergency Department (ED) treatment?
Objective: To construct a valid and reliable Hyperglycemic Crises Death (HCD) Scale using
existing clinical data to predict mortality rate for each patient.
Methods: Rasch analysis was used to validate the items in the HCD scale. The setting was a
700-bed medical center in northern Taiwan. Three hundred and thirty patients visiting the
study hospital ED between January 2004 and December 2010 were included. Two data sets of
derviation and validation were used to determine a cut-off criterion for classifying possible
mortality patients and to verify the effectiveness of the HCD scale, respectively.
Results: The 12-item HCD scale can be fitted to the Rasch model’s requirement. Mortality
rate for each patient can be easily and quickly computed by the Rasch probability formula. A
colorful visual representation of Rasch Wright map could be made available to highlight the
person and item relationship onto the same interval scale to allow direct comparisons.
Conclusions: The HCD scale is a simple and rapid tool for predicting 30-day in-hospital
mortality and suggests ED physicians pay more concerns to these patients with high scaled
scores beyond threshold criterion.