3种评分系统在急诊危重患者预后评估中的对比研究  

Research on three kinds of scoring system for predicting outcomes of severe patients in Emergency Department

作　　者：任艺[1] 邵旦兵[1] 刘红梅[1] 张炜[1] 许宝华[1] 唐文杰[1] 杨志洲[1] 孙宝迪[1] 陈娇[1] 聂时南[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)急救医学科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2013年第5期493-496,共4页Journal of Medical Postgraduates

基　　金：南京军区人才培养"122工程"项目基金(JQZD200905)

摘　　要：目的急诊分诊是急救工作的重要环节,合理的评分系统能使分诊更科学、高效。文中拟探讨改良早期预警评分(modified early warning score,MEWS)、快速急诊内科评分(rapid emergency medicine score,REMS)和急性生理和慢性健康状况评分(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)在评估急诊危重患者预后的性能,并进行对比研究。方法对急诊科412例患者进行MEWS评分、REMS评分和APACHEⅡ评分,追踪患者去向和预后,并根据其当次入院后死亡率,比较3种评分与急诊危重患者预后的相关性,同时通过ROC曲线下面积大小,比较3种评分系统预测预后的性能。结果 3种评分分值越高,死亡危险率越高;MEWS评分、REMS评分和APACHEⅡ评分的ROC曲线下面积及其95%CI分别为0.750(0.685～0.814)、0.763(0.702～0.825)和0.865(0.814～0.915)。结论 3种评分系统均能预测患者的预后,其预测性能为APACHEⅡ>REMS>MEWS;从成本效益方面综合考虑,MEWS评分更适用于急诊患者的早期预后评估。Objective Emergency triage is an important part of the first-aid work, and reasonable scoring system can make it more scientific and efficient. The aim of this study was to study the efficacy of modified early warning score （MEWS） , rapid emergency medicine score （REMS） and acute physiology and chronic health evaluations （ APACHE Ⅱ） score for the prognosis of severe patients in the Emergency Department. Methods MEWS, REMS and APACHEⅡ score were evaluated in 412 patients in the Emergency Department, and then these patients were followed up. The correlations betweent the three kinds of scoring system and prognosis were analyzed in those patients via the mortality of patients. The efficacy of the three kinds of scoring system was compared via the area under the ROC curve. Results With scores increasing, mortality rate increased as well. The area under ROC curve and 95% CI of MEWS, REMS and APACHE Ⅱ. Scores were 0.750 （0. 685 -0. 814） , 0. 763 （0. 702 -0. 825 ） and 0. 865 （0.814 -0. 915 ） respectively. Conclusion All the three kinds of scoring system were useful for predicting the outcomes in severe patients, and the efficacywas APACHE Ⅱ〉 REMS 〉 MEWS. Considering the cost benefit synthetically, MEWS maybe more suitable for the evaluation of prognosis for emergency patients.

关 键 词：改良早期预警评分 快速急诊内科评分 急性生理和慢性健康状况评分 急诊科 ROC曲线 

分 类 号：R195.1[医药卫生—卫生统计学]