比较3种院前伤情评分方法对芦山地震伤员病情严重程度的评估作用  

Comparison of the performance of three prehospital trauma scores in evaluation of injury severity among Lushan earthquake victims

作　　者：何亚荣[1] 胡海[1] 蒋耀文[1] 胡俊飞[1] 李晓辉[1] 姚园场 朱丹[1] 刘伯夫[1] 彭丽媛 王建青[1] 曹钰[1] 

机构地区：[1]四川大学华西医院急诊科,成都610041 [2]四川大学华西临床医学院

出　　处：《中华危重病急救医学》2014年第8期581-584,共4页Chinese Critical Care Medicine

基　　金：国家卫计委公益性行业科研专项（201302003）;国家卫计委应急办项目资助（11WSB-01）

摘　　要：目的 探讨修正创伤评分（RTS）、CRAMS评分[循环（circulation）、呼吸（respiration）、腹部创伤（abdomen）、运动（motor）、语言（speech）]及院前伤情指数（PHI）3种院前创伤评分对地震创伤伤员病情严重程度的评估作用.方法 回顾性分析2013年4月20日四川芦山地震发生至4月27日由四川大学华西医院收治的地震伤员的资料,记录其初始临床信息并计算创伤严重度评分（ISS）、RTS、CRAMS及PHI评分.通过绘制受试者工作特征曲线（ROC曲线）,研究3种院前创伤评分与ISS的拟合情况,并寻找其最佳截断值;通过线性相关分析,探讨ISS与3种院前创伤评分之间的相关性.结果 共纳入263例地震伤员,其中ISS≥16分者86例,＜16分者177例,两组患者间男性比例（67.4％比50.8％,x2=6.477,P=0.011）、RTS评分[分：7.55（0.29）比7.84（0）,U=6 825,P=0.013]和CRAMS评分[分：8（1）比9（1）,U=3 977,P=0.000]差异均有统计学意义.ROC曲线分析显示,RTS、CRAMS和PHI评分的ROC曲线下面积（AUC）分别为0.547（P=0.220）、0.734（P=0.000）和0.544 （P=0.250）,三者的约登指数分别为0.093、0.443和0.119,最佳截断值分别为4.9、9.5和3.5分.线性相关分析显示,RTS、CRAMS与ISS呈显著负相关（r1=-0.139,P1=0.024;r2=-0.413,P2=0.000）,而PHI与ISS无相关性（r=0.071,P=0.250）.结论 在3种院前创伤评分方法中,CRAMS评分与ISS评分的相关性最好,可用于地震后首诊医院医生对伤员创伤严重程度的快速评估.Objective To investigate the performance of revised trauma score （RTS）,CRAMS score （circulation,respiration,abdomen,motor and speech） and prehospital index （PHI） on evaluation of injury severity in earthquake victims.Methods Data of victims admitted to West China Hospital of Sichuan University during the Lushan earthquake from April 20th,2013,to April 27th were retrospectively analyzed.The clinical information at admission was recorded,and the injury severity score （ISS）,RTS,CRAMS and PHI were calculated.The optimal cut-off values were looked for,the comparability between the three scores and ISS score were figured out by receiver operator characteristic curve （ROC curve）,and the correlation between ISS and three scores was analyzed by linear regression analysis.Results There was a total of 263 victims included in the study.ISS ≥ 16 was found in 86 cases,and ISS〈 16 in 177 victims,and there were significant statistic differences in male ratio （67.4% vs.50.8%,x2=6.477,P=0.011）,RTS score [7.55 （0.29） vs.7.84 （0）,U=6 825,P=0.013] and CRAMS scores [8 （1） vs.9 （1）,U=3 977,P=0.000] between two groups.It was showed by ROC curve analysis that the area under the ROC curve （AUC） of RTS,CRAMS and PHI was 0.547 （P=0.220）,0.734 （P=0.000） and 0.544 （P=0.250）,and the Youden indexes of the three scores were 0.093,0.443,and 0.119,respectively.Moreover,the best cut-off values of them were 4.9,9.5 and 3.5.Linear regression analysis showed that RTS and CRAMS score showed negative correlation with ISS score （r1 =-0.139,P1 =0.024; r2=-0.413,P2=0.000）,while PHI showed no relationship with it （r=0.071,P=0.250）.Conclusion Of these three scoring systems,CRAMS has the best correlation with ISS,and it can be used in the prompt assessment of trauma severity in earthquake victims.

关 键 词：地震 创伤 评估 CRAMS评分 修正创伤评分 创伤严重度 

分 类 号：R641[医药卫生—外科学]