三种不同评分在急诊危重患者预后评估中的对比研究  

Study of different score systems on predicting outcomes in severe patients of emergency departments

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]南京军区南京总医院急救医学科,南京大学医学院,南京210002

出　　处：《中华急诊医学杂志》2014年第1期71-74,共4页Chinese Journal of Emergency Medicine

基　　金：南京军区人才培养“122工程”项目基金资助（JQZD200905）;南京军区南京总医院青年基金资助（2011030）

摘　　要：目的探讨简单临床评分（simpleclinicalscore，SCS）、快速急诊内科评分（rapidemergencymedicinscore，REMS）和APACHEⅡ评分在评估急诊危重患者预后的作用效果，并进行对比研究。方法对急诊科412例患者进行SCS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病死率，比较三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，比较三种评分系统预测预后的准确度。结果SCS评分、REMS评分和APACHEⅡ评分分值越高，死亡危险率越高，各分组问病死率比较差异均有统计学意义（P〈0．01）；SCS评分、REMS评分和APACHEⅡ评分的ROC曲线下面积分别为0．801、0．763和0．865，SCS和APACHEⅡ评分比较ROC曲线下面积差异具有统计学意义（P〈0．01），REMS和APACHEⅡ评分比较ROC曲线下面积差异具有统计学意义（P〈0．01），SCS和REMS评分比较ROC曲线下面积差异无统计学意义（P〉0．05）。结论三种评分系统均能预测患者的预后，其预测准确度为APACHEⅡ高于SCS高于REMS；从成本效益方面考虑，SCS评分更适用于急诊患者的早期预后评估。Objective To evaluate the simple clinical score （ SCS）, rapid emergency medicin score （REMS） and APACHE ]I score in predicting prognosis of severe patients in emergency department. Methods Data of 412 patients were collected at and after admission. SCS score, REMS score and APACHE 11 score were calculated in 24 hours after admission. The mortality of patients with different score system was analyzed in order to evaluate the sensitivity and specificity of the three score system confirmed by area under the ROC curve. Results With scores increase, mortality rate increased as a resuh of severity of illness. There were differences in mortality rate among the three score system （P 〈0. 01 ）. The areas under ROC curves of SCS, REMS and APACHE II score were 0. 801, 0. 763 and 0. 865. The difference in area under the ROC curve between SCS and APACHE II score was significant （ P 〈 0. 0i ）, and difference in area under the ROC curve between REMS and APACHE II score was also significant （ P 〈 0. 01 ） , while there was no significant difference in area under the ROC curve between SCS and REMS score （ P 〉 0. 05 ）. Conclusions The three different score systems were useful in predicting outcomes of severe patients, and SCS is more reliable in emergency department.

关 键 词：简单临床评分 快速急诊内科评分 APACHE II评分 急诊科 ROC曲线 

分 类 号：R459.7[医药卫生—急诊医学]