161004 JIPADって何？

JIPADって何？
＋慈恵におけるGATEWAY
2016/10/4
慈恵ICU火曜勉強会
内野滋彦
WHAT IS JIPAD?
WHAT IS JIPAD?
Systemic Inflammatory Response Syndrome
Criteria in Defining Severe Sepsis
Kirsi-Maija Kaukonen, M.D., Ph.D., Michael Bailey, Ph.D., David Pilcher, F.C.I.C.M.,
D. Jamie Cooper, M.D., Ph.D., and Rinaldo Bellomo, M.D., Ph.D.
Ø72 intensive care units in Australia and New
A BS T R AC T
Zealand from 2000 through 2013.
BACKGROUND
ØPatients
with infection and organ failure
The consensus definition of severe sepsis requires suspected or proven infection,
ØSIRS-positive
SIRSsepsis
organ
failure, and signs thator
meet
two or negative
more criteria severe
for the systemic
inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and
Ø109,663
infection
construct
validity ofhad
this approach.
METHODS
Ø87.9%
had SIRS-positive severe sepsis
We studied data from patients from 172 intensive care units in Australia and New
Zealand from 2000 through 2013. We identified patients with infection and organ
failure and categorized them according to whether they had signs
meeting
two or
WHAT
IS JIPAD?
B Adjusted Annual Odds of Death
1.6
1.4
Odds of Death
1.2
1.0
0.8
0.6
0.4
0.2
13
20
12
20
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
19
99
0.0
Figure 1. Mortality among Patients with Severe Sepsis, According to Status
with Respect to Criteria for the Systemic Inflammatory Response Syndrome
(SIRS).
Patients were categorized according to whether they had symptoms meeting two or more SIRS criteria (SIRS-positive sepsis) or symptoms meeting
less than two SIRS criteria (SIRS-negative sepsis). Panel A shows the un- WHAT IS JIPAD?
Patients Wh
B Adjusted Annual Odds of Death
1.6
1.4
10
5
1.2
Odds of Death
15
0
1.0
1
2
3
4
No. of SIRS Criteria Met
0.8
B Adjusted Odds of Death
0.6
2.0
0.4
1.8
1.6
0.2
20
05
20
04
20
03
20
02
20
01
20
00
20
99
06
Odds of2 Death
00
7
20
08
20
09
20
10
20
11
20
12
20
13
1.4
0.0
19
0
1.2
1.0
0.8
Figure 1. Mortality among Patients with Severe0.6Sepsis, According to Status
with Respect to Criteria for the Systemic Inflammatory Response Syndrome
0.4
(SIRS).
0.2
Patients were categorized according to whether they had symptoms meet0.0
ing two or more SIRS criteria (SIRS-positive sepsis) or 0symptoms
1 meeting
2
3
4
less than two SIRS criteria (SIRS-negative sepsis). Panel A shows
un-Criteria
WHATMet
IS JIPAD?
No. ofthe
SIRS
admisU) and
he sys(SIRS)
expreson.3 In
mptoms
e sepsis
sepsis,
r of infied by
College
al Care
minant
ME THODS
STUDY DESIGN
We conducted a retrospective study from January
1, 2000, to December 31, 2013, using data from
the Australia and New Zealand Intensive Care
Society (ANZICS) Adult Patient Database (APD),16
a high-quality database run by the ANZICS Centre for Outcome and Resource Evaluation. The
ANZICS APD includes information on more than
90% of all ICU admissions in Australia and New
Zealand. The Alfred Hospital Human Research
Ethics Committee, Melbourne, Australia, approved the study with a waiver of informed consent. The data were gathered as a part of routine
WHAT IS JIPAD?
two or quality-assurance benchmarking processes
by
データベースでNEJMかいっ！！！
JAMAもかいっ！
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
80% of all ICUs
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
AIMS of ANZICS-CORE
• Provide a peer review mechanism for contributing adult
and paediatric ICUs by providing data processing and
reporting facilities
• Provide reliable information to clinicians, policy makers,
health care providers and state and federal governments
• Develop research focus and activities of the ANZICS
CORE through local, national and international
collaboration
• Promote research activities directed at greater
understanding of critical illness, its management and
outcome
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
JIPADの歩み
年月
2011年7月
ICU学会DB作成準備 WG発足
2011年11月 ICU機能評価委員会で事業計画
2012年7月
ANZICS-COREと合意、情報提供、収集項目決定
2013年1月
パイロットスタディ（5施設）
2013年3月
学術総会にて結果報告、参加呼びかけ
2014年1月
本格稼働
2015年2月
8施設、968例
2015年3月
サイトビジットなど積極的な活動開始
WHAT IS JIPAD?
治療内容
重症度スコア
入退院／入退室
病名リスト
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
16歳以上
APACHE III
APACHE II
SAPS II
15歳以下
PIM 2
WHAT IS JIPAD?
WHAT IS JIPAD?
Research
Intensive Care National Audit & Research Centre, London, UK
1Statistician,
Open Access
Statistician,
Intensive Care and
National
Audit & Research
Centre,
UK
Case
mix, outcome
length
of stay
forLondon,
admissions
to adult,
Intensive Care National Audit & Research Centre, London, UK
general critical care units in England, Wales and Northern
Ireland: the Intensive Care National Audit & Research Centre
Correspondence:
A Harrison, [email protected]
Case Mix David
Programme
Database
2Senior
3Director,
David A Harrison1, Anthony R Brady2 and Kathy Rowan3
Received:
6 November 2003
1
Statistician, Intensive Care National Audit & Research Centre, London, UK
2Senior Statistician, Intensive Care National Audit & Research Centre, London, UK
Revisions
requested:
6 January 2004
3Director, Intensive
Care National Audit & Research Centre, London, UK
Revisions received: 28 January 2004
Correspondence: David A Harrison, [email protected]
Accepted: 13 February 2004
Received: 626
November
2003 2004
Published:
February
Revisions requested: 6 January 2004
Revisions received: 28 January 2004
Abstract
Accepted: 13 February 2004
Published: 26 February 2004
Critical Care 2004, 8:R99-R111 (D
This article is online at http://ccforu
© 2004 Harrison et al., licensee Bi
(Print ISSN 1364-8535; Online ISSN
Access article: verbatim copying an
permitted in all media for any purpo
Critical Care 2004, 8:R99-R111
(DOI 10.1186/cc2834)
preserved
along with the article's o
This article is online at http://ccforum.com/content/8/2/R99
© 2004 Harrison et al., licensee BioMed Central Ltd
(Print ISSN 1364-8535; Online ISSN 1466-609X). This is an Open
Access article: verbatim copying and redistribution of this article are
permitted in all media for any purpose, provided this notice is
preserved along with the article's original URL.
Introduction The present paper describes the methods of data collection and valida
the Intensive Care National Audit & Research Centre Case Mix Programme (C
Abstract
comparative audit of outcome for adult, critical care admissions. The paper also de
Introduction The present paper describes the methods of data collection and validation employed in
mix, outcome and activity of the admissions in the Case Mix Programme Database (C
the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national
Methods
CMP forcollects
data
consecutive
admissions
comparative
auditThe
of outcome
adult, critical
careon
admissions.
The paper
also describesto
theadult,
case general crit
mix,England,
outcome andWales
activity ofand
the admissions
in the
Case MixExplicit
Programme
Database
Northern
Ireland.
steps
are(CMPD).
taken to ensure the accu
Methods The CMP collects data on consecutive admissions to adult, general critical care units in
IS JIPAD?
including
of a dataset
initial
and the
refresher
training
courses,
and o
England,
Walesuse
and Northern
Ireland. specification,
Explicit steps are of
taken
to ensure
accuracyWHAT
of the data,
Open Access
Research
Intensive Care National Audit & Research Centre, London, UK
1Statistician,
Figure 2
Statistician,
Intensive Care and
National
Audit & Research
Centre,
UK
Case
mix, outcome
length
of stay
forLondon,
admissions
to adult,
Intensive Care National Audit & Research Centre, London, UK
general critical care units in England, Wales and Northern
Ireland: the Intensive Care National Audit & Research Centre
Correspondence:
A Harrison, [email protected]
Case Mix David
Programme
Database
2Senior
3Director,
David A Harrison1, Anthony R Brady2 and Kathy Rowan3
Received:
6 November 2003
1
Statistician, Intensive Care National Audit & Research Centre, London, UK
2Senior Statistician, Intensive Care National Audit & Research Centre, London, UK
Revisions
requested:
6 January 2004
3Director, Intensive
Care National Audit & Research Centre, London, UK
Revisions received: 28 January 2004
Correspondence: David A Harrison, [email protected]
Accepted: 13 February 2004
Received: 626
November
2003 2004
Published:
February
Revisions requested: 6 January 2004
Revisions received: 28 January 2004
Abstract
Accepted: 13 February 2004
Published: 26 February 2004
Critical Care 2004, 8:R99-R111 (D
This article is online at http://ccforu
© 2004 Harrison et al., licensee Bi
(Print ISSN 1364-8535; Online ISSN
Access article: verbatim copying an
permitted in all media for any purpo
Critical Care 2004, 8:R99-R111
(DOI 10.1186/cc2834)
preserved
along with the article's o
This article is online at http://ccforum.com/content/8/2/R99
© 2004 Harrison et al., licensee BioMed Central Ltd
(Print ISSN 1364-8535; Online ISSN 1466-609X). This is an Open
Access article: verbatim copying and redistribution of this article are
permitted in all media for any purpose, provided this notice is
preserved along with the article's original URL.
Introduction The present paper describes the methods of data collection and valida
the Intensive Care National Audit & Research Centre Case Mix Programme (C
Abstract
comparative audit of outcome for adult, critical care admissions. The paper also de
Introduction The present paper describes the methods of data collection and validation employed in
mix, outcome and activity of the admissions in the Case Mix Programme Database (C
the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national
Methods
CMP forcollects
data
consecutive
admissions
comparative
auditThe
of outcome
adult, critical
careon
admissions.
The paper
also describesto
theadult,
case general crit
mix,England,
outcome andWales
activity ofand
the admissions
in the
Case MixExplicit
Programme
Database
Northern
Ireland.
steps
are(CMPD).
taken to ensure the accu
Methods The CMP collects data on consecutive admissions to adult, general critical care units in
IS JIPAD?
including
of a dataset
initial
and the
refresher
training
courses,
and o
England,
Walesuse
and Northern
Ireland. specification,
Explicit steps are of
taken
to ensure
accuracyWHAT
of the data,
An example of the Intensive Care National Audit & Research Centre Coding Method — bacterial pneumonia.
Open Access
Research
Case mix, outcome and length of stay for admissions to adult,
general critical care units in England, Wales and Northern
Ireland: the Intensive Care National Audit & Research Centre
Case Mix Programme Database
David A Harrison1, Anthony R Brady2 and Kathy Rowan3
1Statistician,
Intensive Care National Audit & Research Centre, London, UK
Statistician, Intensive Care National Audit & Research Centre, London, UK
3Director, Intensive Care National Audit & Research Centre, London, UK
2Senior
Correspondence: David A Harrison, [email protected]
Received: 6 November 2003
Critical Care 2004, 8:R99-R111 (DOI 10.1186/cc2834)
Revisions requested: 6 January 2004
This article is online at http://ccforum.com/content/8/2/R99
Revisions received: 28 January 2004
Accepted: 13 February 2004
Published: 26 February 2004
© 2004 Harrison et al., licensee BioMed Central Ltd
(Print ISSN 1364-8535; Online ISSN 1466-609X). This is an Open
Access article: verbatim copying and redistribution of this article are
permitted in all media for any purpose, provided this notice is
preserved along with the article's original URL.
Abstract
Introduction The present paper describes the methods of data collection and validation employed in
the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national
comparative audit of outcome for adult, critical care admissions. The paper also describes the case
mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD).
Methods The CMP collects data on consecutive admissions to adult, general critical care units in
England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data,
WHAT IS JIPAD?
ICU DIAGNOSIS – REASON FOR ICU ADMISSION
Tick one admission diagnosis from either a non-op. or post-operative group (see list below).
If “ICU Admission Source” is entered as “OT/Recovery” then the APACHE diagnosis entry must be from the post-operative group.
Non-operative
Parasitic Pneumonia
Bacterial Pneumonia
Viral Pneumonia
Other Respiratory Disease
Cardiovascular
Cardiogenic Shock
Cardiac Arrest
Aortic Aneurysm
Congestive Heart Failure
Peripheral Vasc. Disease
Rhythm Disturbance
Acute Myocardial Infarct.
Hypertension
Cardiomyopathy
Unstable Angina
Other Cardiovasc. Disease
Respiratory
Aspiration Pneumonia
Resp Neoplasm incl. larynx/trachea
Respiratory Arrest
Pulm.Oedema (non-cardiac)
COPD
Pulmonary Embolism
Mechanical Airway Obstruct.
Asthma
Gastrointestinal
Hepatic Failure
GI Bleeding - Varices
GI Bleeding - Ulcer/lacerat.
GI Bleeding - Diverticulosis
GI Perforation
GI Obstruction
GI Vascular Insufficiency
Pancreatitis
GI Cancer
Other GI Inflammatory Disease
Other GI Disease
Neurological
Intracerebral Haemorrhage
Subarachnoid Haemorrhage
Stroke
If Acute Myocardial Infarction – Thrombolytic therapy?
Yes
No
Neurologic Infection
Neurologic Neoplasm
Neuromuscular Disease
Seizure
Epidural haematoma
Coma
Other Neurologic Disease
Sepsis
Sepsis (other than Urinary)
Sepsis of Urinary Tract Origin
Sepsis with Shock (not urinary)
Sepsis - UT Origin with Shock
Trauma
Head Trauma +/- Multi Trauma
Multiple Trauma excl. Head
Burns
Multi. Trauma – Spin. Cord Inj.
Isolated Cervical Cord Injury
Metabolic
Metabolic Coma
Diabetic Ketoacidosis
Drug Overdose
Other Metabolic Diseases
Haematological
Coagulop./Neutro./Thromb.
Other Haem. Diseases
Genitourinary
Renal Diseases
Pre-eclampsia
Haemorrhage, post partum
Musculoskeletal/skin
Musculoskeletal/skin Disease
Cellulitis/soft tissue infection
Other
Other medical diseases
(Use only if ‘Other Diseases
in specific organ system is
inappropriate)
Unknown
Post-operative
Cardiovascular
Periph. Vascular Dis. – no Graft
Periph. Artery Bypass Graft eg
Fempop
Elective AA Surgery
Carotid Endarterectomy
Valvular Heart Surgery
(CABG) Coronary Artery Bypass
Graft
Dissecting Aortic Aneurysm
Ruptured Aortic Aneurysm
Aorto-femoral bypass Graft
CABG with Valve repair
replacement
Endoluminal Aortic Repair
Other Cardiovascular Diseases
Neopl.M’th/larynx/sinus/trach.
Other Respiratory Disease
Gastrointestinal
GI Perforation/Rupture
GI Bleeding
GI Obstruction
GI Neoplasm
Cholecystitis/cholangitis
Liver Transplant
Fistula/Abscess surgery
GI Vascular ischemia resection
surgery
Peritonitis
Pancreatitis
Other GI Inflammatory Disease
Other GI Disease
Respiratory
Respiratory Infection
Respiratory Neoplasm - Lung
If CABG – CABG redo?
Yes
Neurologic
Intracerebral Haemorrhage
Subdural/Epidur. Haematoma
Subarachnoid Haemorrhage
Laminectomy/Spin. Cord Surg.
Craniotomy for Neoplasm
Other Neurologic Disease
Musculoskeletal/skin
Orthopedic. surgery
Skin surgery
Cellulitis/soft tissue infection
Trauma
Head Trauma +/- Multi Trauma
Multi Trauma excluding Head
Multi Trauma + Spinal Cord
Burns
Isolated Cervical Spine Injury
No
Diagnostic sub code (optional, see Appendix B) ____________________________________
Metabolic
Metabolic Diseases
Haematological
Haematologic Diseases
Genitourinary
Renal Neoplasm
Kidney Transplant
Genitourinary/procedure
Other Renal Diseases
Gynaecologic
Hysterectomy
Pregnancy related Disorder
Other Gynaecologic Diseases
No of coronary arteries grafted? ____________
WHAT IS JIPAD?
WHAT IS JIPAD?
REVIEW
Clinical review: Scoring systems in the critically ill
Vincent and Moreno Critical Care 2010, 14:207
http://ccforum.com/content/14/2/207
Page 2 of 9
Vincent and Moreno Critical Care 2010, 14:207
http://ccforum.com/content/14/2/207
Table 1. Comparison of general outcome prediction models
Jean-Louis Vincent*1 and Rui Moreno2
APACHE
SAPS
APACHE II
MPMa
Abstract
Characteristics
[3]
[10]
[4]
[14]
General illness severity
scores
the
Year
1981
1984 are widely
1985used in1985
ICU to predict outcome,
characterize
disease
severity
Countries
1
1
1
1
and degree of organ dysfunction, and assess resource
ICUs
2
8
13
1
use. In this article we review the most commonly used
Patients
5,815
2,783
scoring systems 705
in each of 679
these three
groups. We
Selection
of the history
Panel of thePanel
Panel of theMultiple
examine
development
initial
variables and
of
of
of
logistic
major systems experts
in each group,
discussexperts
the construction
their weights
experts
regression
of subsequent versions, and, when available, provide
Variables
recent comparative data regarding their performance.
Age
Yes of scores
Yes shouldYes
Importantly,
the No
different types
be
Origin
No
No
No
No
seen as complementary, rather than competitive and
mutually
Surgical exclusive.
status No It is possible
No that their
Yes combined
Yes
useChronic
could provide
indication
of Yes
Yesa more accurate
No
Yes
healthseverity
status
disease
and prognosis. All these scoring
systems
will need
withYes
time as ICU
Physiology
Yesto be updated
Yes
Yes
populations
change
Acute diagnosis
No and new
No diagnostic,
Yes therapeutic
No
and prognostic techniques become available.
ThIIIe objective
thisIIb review
is3 to APACHE
give the
APACHE
SAPS II ofMPM
SAPS
IV intensivist
MPM III
[5]without [11]
[15]
[12]
[8]
any particular knowledge or expertise [17]
in this
1991
area
1993of the 2005
an1993overview
current 2006
status of2007
these
For a1 more
1 instruments
12 and their
12 possible
35 applications.
1
explanation
40detailed 137
140of the development,
303
104application
135 and
limitations of these models, the reader is referred to a
17,440
12,997
19,124
16,784
110,558
124,855
recent review [1].
REVIEW
Multiple
Multiple
Multiple
Multiple
logistic
logistic
logistic
logistic
Outcome
prediction
regression
regression
regressionscores
regression
Multiple
logistic
regression
Multiple
logistic
regression
Clinical review: Sc
Number of variables 34
14
17
11
The original outcome prediction scores were developed
more than 25 years ago to provide an indication of the
Yes
Yes
Yes
Yes
Yes
Yes
risk of death of groups of ICU patients; they were not
YesdesignedNofor individual
No
Yes
Yes Patient No
prognostication.
demoYesgraphics,Yes
Yes
Yes
Yes
Yes
disease prevalence, and intensive care practice
1 since
2
considerably
Yeshave changed
Yes
Yes
Yes [2], and
Yes statistical
Yes and
computational techniques have also progressed. As a
Yesresult, allYesthree of the
Yes major scores
Yes
Yes category
Yeshave
in this
updated
accuracy
Yesbeen recently
No
Yes to ensure
Yes their continued
Yes
Yes
26in today’s17ICU (Table 1).
15c
20
142
16d
Score
Yes
Yes
No
Yes
Jean-Louis Vincent* and Rui Moreno
Yes
No
Yes
Yes
No
Abstract
Yes
Yes
Yes
Yes
Yes
The original
APACHE
score Yes
was developed
in 1981
to
Mortality prediction No
No
Yes
Yes
Introduction
These models
are basedused
on previous
versions, developed
by the same
authors.
Scoring
systems
in critically
ill patients
can
be
a
Yes
Acute Physiology and Chronic Health Evaluation
WHAT IS JIPAD?
Theclassify
numbers presented
for the according
admission component
of the model
groupsare
ofthose
patients
to severity
of illness
b
REVIEW
Clinical review: Scoring systems in the critically ill
Vincent and Moreno Critical Care 2010, 14:207
http://ccforum.com/content/14/2/207
Page 2 of 9
Vincent and Moreno Critical Care 2010, 14:207
http://ccforum.com/content/14/2/207
Vincent
and1.
Moreno
Critical of
Care
2010, 14:207
Page 4 o
Table
Comparison
general
outcome prediction models
Jean-Louis Vincent*1 and Rui Moreno2
http://ccforum.com/content/14/2/207
ThIIIe objective
thisIIb review
is3 to APACHE
give the
APACHE
SAPS
APACHE II
MPMa
APACHE
SAPS II ofMPM
SAPS
IV intensivist
MPM III
Abstract
Characteristics
[3]
[10]
[4]
[14]
[5]without [11]
[15]
[12]
[8]
any particular knowledge or expertise [17]
in this
General illness severity
scores
the
Year
1981
1984 are widely
1985used in1985
1991
1993of the 2005
area an1993overview
current 2006
status of2007
these
ICU to predict outcome,
characterize
disease
severity
For a1 more
Countries
1
1
1
1
1 instruments
12 and their
12 possible
35 applications.
1
Tableand
2. Comparison
of
three
organ
dysfunction
scores
degree of organ dysfunction, and assess resource
explanation
ICUs
2
8
13
1
40detailed 137
140of the development,
303
104application
135 and
use.
In
this
article
we
review
the
most
commonly
used
Characteristics
LODS [29]
MODS [30]
SOFA [31]
limitations
of these models, the reader
is referred to a
Patients
705
679
5,815
2,783
17,440
12,997
19,124
16,784
110,558
124,855
scoring
systems
in
each
of
these
three
groups.
We
recent
review [1].
Year of publication
1996
1995
1996
Selection
of the history
Panel of thePanel
Panel of theMultiple
Multiple
Multiple
Multiple
Multiple
Multiple
Multiple
examine
development
initial
variables
and
of weightsof
of logisticlogistic
logistic Literature
logisticreviewlogistic
logistic Panellogistic
logistic
Selection
of
variables
and
their
Multiple
regression
and
logistic
of
experts
major systems experts
in each group,
discussexperts
the construction
Outcome
prediction
scores
their weights
experts
regression regression
regression
regression
regression
regression
regression
regression
of subsequent versions, and, when available, provide
Th
e
original outcome prediction scores were developed
Variables
Variables
used
to
assess
organ
dysfunction
recent comparative data regarding their performance.
more than 25 years ago to provide an indication of the
Age
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Importantly, the different types ofGlasgow
scores should
be
Neurologic
Coma Scale
Coma
Glasgow Coma
risk Glasgow
of death
of Scale
groups of ICU patients;
they Scale
were not
Origin
No
No than competitive
No
No
YesdesignedNofor individual
No
Yes
Yes Patient No
seen
as complementary,
rather
and
prognostication.
Cardiovascular
Heart rate, systolic blood
Pressure-adjusted heart rate
Mean arterial
blood demopressure,
mutually
their
combined
Surgical exclusive.
status No It is possible
No that
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
pressure
vasopressor care
use practice
graphics, disease prevalence, and intensive
1
2
useChronic
could provide
a
more
accurate
indication
of
changed
considerably
since
and
statistical
Yes
No
Yesurea or urea
Yesnitrogen, YeshaveSerum
Yes
Yes
Yes [2],
Yes
Yes and
Renal
Serum
creatinine
Serum
creatinine,
urine
output
healthseverity
status
disease
and prognosis. Allcreatinine,
these scoring
computational techniques have also progressed. As a
urine output
systems
will need
withYes
time as ICU
Physiology
Yesto be updated
Yes
Yes
Yesresult, allYesthree of the
Yes major scores
Yes
Yes category
Yeshave
in this
Respiratory
PaO2/FiO2 ratio, mechanical
PaO2/FiO2 ratio
PaO2/FiO2 ratio, mechanical
populations
change
updated
continued
accuracy
Acute diagnosis
No and new
No diagnostic,
Yes therapeutic
No
Yesbeen recently
No
Yes to ensure
Yes their
Yes
Yes
ventilation
ventilation
and prognostic techniques become available.
Number of variables 34
14
17
11
26in today’s17ICU (Table 1).
15c
20
142
16d
REVIEW
Clinical review: Sc
Jean-Louis Vincent* and Rui Moreno
Hematologic
Score
Yes
Yes
White blood cell count,
platelet
Yes count No
Platelet count
Yes
Yes
Abstract
Platelet count
No
Yes
Yes
Acute Physiology and Chronic Health Evaluation
Serum
time
SerumYes
bilirubin Yes
bilirubin
Yesbilirubin, prothrombin
Yes
Yes
Yes SerumYes
No
Hepatic
Mortality prediction No
No
Yes
Introduction
The original APACHE score was
developed
inJIPAD?
1981
to
WHAT
IS
These
models
are
based
on
previous
versions,
developed
by
the
same
authors.
The
numbers
presented
are
those
for
the
admission
component
of
the
model
LODS,
Logistic
Organ
Dysfunction
Score;
MODS,
Multiple
Organ
Dysfunction
Score;
SOFA,
Sequential
Organ
Dysfunction
Score.
Scoring systems used in critically ill patients can be classify groups of patients according to severity of illness
a
b
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WHAT IS JIPAD?
何故APACHE III-jなのか？
• APACHE IIやSAPS IIと異なり、キャリブ
レーションの時期が21世紀
• おまけでAPACHE IIとSAPS IIが付いてくる
• APACHE IVへの移行が比較的容易
WHAT IS JIPAD?
Owner: Critical Care and Emergency Medicine ABU
JIPAD?
Even though the APACHE III score is the most critical componentWHAT
of theISpredictive
何故APACHE III-jなのか？
• APACHE IIやSAPS IIと異なり、キャリブ
レーションの時期が21世紀
• おまけでAPACHE IIとSAPS IIが付いてくる
• APACHE IVへの移行が比較的容易
• JIPAD的に、
ØANZICSと同じ
Ø主病名のコード化
WHAT IS JIPAD?
WHAT IS JIPAD?
全147ページ
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
収集データの質の担保
1. サイトビジット
• 目的：各施設の状況を理解することにより、
データの質を維持し、負担をできるかぎり減
らせるような情報提供を行うこと
• ”顔見知り”になる
• 朝の回診やカンファレンスに参加
• 使用している入力システムや、実際に入力さ
れているところを拝見
• 提案、あれば質問に回答
• 2015年3月から開始、現在まで21ヶ所を訪問
WHAT IS JIPAD?
2016年10月時点で合計23+2施設
WHAT IS JIPAD?
WHAT IS JIPAD?
収集データの質の担保
2. 免許皆伝制度
• 参加施設より10例ずつデータをアップ
• こちらでデータの内容を確認、入力ミスなどにつ
いてのコメントを返信
• 参加施設はコメントの内容を確認し、必要であれ
ばデータを修正して再アップ
• 指摘内容を参考に、次の10例のデータ入力を行う
• 10例全てで入力ミスがなくなるまでこのプロセス
を継続
• ミスがなくなったら”免許皆伝”、それ以降は自
由にデータをアップしてＯＫ
WHAT IS JIPAD?
ANZICS-APD in Auckland, NZ, 2015
WHAT IS JIPAD?
ICNARC in London, UK, 2016
WHAT IS JIPAD?
25000
2000
1800
20000
1600
1400
15000
1200
1000
10000
800
600
5000
400
200
0
0
201508 201509 201510 201511 201512 201601 201602 201603 201604 201605 201606 201607 201608 201609 201610 201611 201612
WHAT IS JIPAD?
JIPAD参加のメリット
• 本邦のICUデータベースへの貢献
• ファイルメーカーがそのまま自施設のデータ
ベースになる
• 他施設（国外含む）との比較が可能
• 全データを研究目的に利用可能
Ø DPCなど他のデータベースと結合？
WHAT IS JIPAD?
JIPADの話は一旦終了。
次はGATEWAYについて。
WHAT IS JIPAD?
慈恵ICUデータベースの歴史
2006年4月集中治療部設置。それ以前から患者台帳をファ
イルメーカーで管理。
WHAT IS JIPAD?
慈恵ICUデータベースの歴史
2006年4月集中治療部設置。それ以前から患者台帳をファ
イルメーカーで管理。
2007年1月重症度スコア、治療内容を含むデータベースの
運用開始。重症度スコアは24時間以上滞在患者
に対してのみ。
WHAT IS JIPAD?
WHAT IS JIPAD?
慈恵ICUデータベースの歴史
2006年4月集中治療部設置。それ以前から患者台帳をファ
イルメーカーで管理。
2007年1月重症度スコア、治療内容を含むデータベースの
運用開始。重症度スコアは24時間以上滞在患者
に対してのみ。
2009年7月 12床から20床に増床、PIMS導入。
2010年1月 PIMSを用いたデータベースを作成。重症度ス
コアを全患者について収集開始。
WHAT IS JIPAD?
WHAT IS JIPAD?
慈恵ICUデータベースの歴史
2006年4月集中治療部設置。それ以前から患者台帳をファ
イルメーカーで管理。
2007年1月重症度スコア、治療内容を含むデータベースの
運用開始。重症度スコアは24時間以上滞在患者
に対してのみ。
2009年7月 20床に増床、PIMS導入。
2010年1月 PIMSを用いたデータベースを作成。重症度ス
コアを全患者について収集開始。
2013年1月日本集中治療医学会の多施設データベース
（Japanese Intensive care PAtient Database,
JIPAD）に基づき、収集項目を大幅に改訂。
WHAT IS JIPAD?
慈恵ICUデータベースの歴史
2006年4月集中治療部設置。それ以前から患者台帳をファ
イルメーカーで管理。
2007年1月重症度スコア、治療内容を含むデータベースの
運用開始。重症度スコアは24時間以上滞在患者
に対してのみ。
2009年7月 20床に増床、PIMS導入。
2010年1月 PIMSを用いたデータベースを作成。重症度ス
コアを全患者について収集開始。
2013年1月日本集中治療医学会の多施設データベース
（Japanese Intensive care PAtient Database,
JIPAD）に基づき、収集項目を大幅に改訂。
2015年4月 GATEWAY開発終了、慈恵ICUに初導入。
WHAT IS JIPAD?
WHAT IS JIPAD?
明るい黄色と
暗い黄色と
灰色
色分け
点線で囲まれた項目
WHAT IS JIPAD?
GATEWAY業務：担当の分担
• 入室時：患者基本情報（赤ボタン）
• 24時間経過：重症度スコア（青ボタン）
• 日々の診療：治療内容、人工呼吸器
• 退室時：退室時情報、全体チェック（緑ボタン）
WHAT IS JIPAD?
GATEWAY業務：担当の分担
• 入室時：患者基本情報（赤ボタン）
• 24時間経過：重症度スコア（青ボタン）
• 日々の診療：治療内容、人工呼吸器
• 退室時：退室時情報、全体チェック（緑ボタン）
内野担当
• 毎週火曜日：退室一週間以上経過した症例の最終
チェック、データロック、PIMS上の保存
• 毎月上旬：先月退院症例の退院時転帰の取り込み
WHAT IS JIPAD?
患者情報システム各社の対応状況
Ø PHILIPS：PIMS, ACSYS
Ø 日本光電：CAP, Gaia
Ø 富士フィルム：Prescient
Ø フクダ電子：Mirrel
Ø 富士通：EG-MAIN
Ø ソフトウェアサービス
WHAT IS JIPAD?
患者情報システムを使用した
データ取り込みの問題点
ØPHILIPS以外では、患者情報システムが出力
したCSVファイルをJIPADに取り込む：デー
タ移動の手間
Ø記録データの不備
• バイタルサインの異常値：動脈圧、呼吸数
• 開始終了時間の実際との不一致：入退室時
間、人工呼吸器
WHAT IS JIPAD?
実際にGATEWAYを使ってみよう
リスト画面
Øソートが出来る
Øフィルター設定
患者詳細画面
ØツールバーをONすると分かり易い
Ø検索方法：検索実行キャンセル
• 新規検索条件
• 一致するレコード
• 演算子
Øレコードのエクスポートと保存
WHAT IS JIPAD?
データベースの利用方法
データベースの解析
Ø 自施設の評価、運営のための情報
Ø 他施設との比較（多施設データベース）
Ø 研究（多施設データベースを用いて）
研究のための情報提供
Ø 疾患・治療の検索
Ø 患者背景などの情報提供
Ø 他のデータとの結合：Excelを使いこなす
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
WHAT IS JIPAD?
•
•
•
•
サイトビジット終了、免許皆伝を取得した11施設
16歳以上、再入室は初回のみ
予定術後で24時間以内の生存退室例を除外
身長もしくは体重の情報のない症例も除外
5839症例
• Underweight (<18.5):
826例
• Lower normal (18.5-23): 2506例
• Higher normal (23-25): 1084例
• Overweight (25-30):
1167例
• Obese (>30):
246例
WHAT IS JIPAD?
Multivariable logistic regression
analysis for hospital mortality
Obese
Overweight
Higher normal
Lower normal
Underweight
0
0.5
1
1.5
2
2.5
WHAT IS JIPAD?
JIPADの今後
Ø 年次レポートの作成：2015年度より
Ø 収集項目の追加：乳酸、HFNC、SOFA
Ø Internationalなデータベースへの参加
Ø データ収集システム、ホームページの充実
WHAT IS JIPAD?
JIPADの今後
WHAT IS JIPAD?
JIPADの今後
Ø 年次レポートの作成：2015年度より
Ø 収集項目の追加：乳酸、HFNC、SOFA
Ø Internationalなデータベースへの参加
Ø データ収集システム、ホームページの充実
Ø 金！かね！カネ！
WHAT IS JIPAD?
WHAT IS JIPAD?

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