新创伤评分法在急诊中预测患者病死率的临床应用  

The clinical application of new trauma scoring method in predicting patients＇ fatality rate in department of emergency

作　　者：赵红亮 刘蕊芝 张芸华 牛东升 

机构地区：[1]山西省晋城市人民医院急诊科,048026

出　　处：《中国医师进修杂志》2015年第6期427-432,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨新创伤评分法即格拉斯哥昏迷评分（GCS）、年龄和收缩压评分（GAP）对急诊创伤患者的伤情判定和病死率预测的准确性.方法 收集27 706例急诊创伤患者的临床资料.观察终点分为3类：到达急诊科或急救中心后24 h内死亡,即24 h死亡;到达急诊科或急救中心24h至到达急诊科或急救中心7d死亡,即24 h后死亡;其他创伤患者均视为存活.在创伤机制、GCS、年龄和收缩压评分（MGAP）的基础上,采用GAP方法对急诊创伤患者的院内病死率进行预测和伤情的判定,对比分析GAP预测病死率的准确性与修正创伤评分（RTS）、创伤严重程度评分（TRISS）和MGAP的差异.各项评分方法对创伤患者病死率的预测准确性计算采用C-statistics方法.结果 GAP预测24 h后病死率和24 h病死率的C值（0.936和0.961）分别比RTS（0.917和0.958）和MGAP（0.920和0.950）高,但略低于TRISS（0.950和0.970）.GAP方法将3～ 10分判定为重伤,11～ 18分判定为缓和伤,19～24分判定为轻伤.结论 GAP方法具有简便、实用性强、伤情判定和病死率预测准确性高的特点,可帮助医生制定合理的救治方案.Objective To investigate the accuracy of the new trauma scoring method：Glasgow coma score （GCS）,age and systolic pressure score （GAP）,in diagnosing patients＇ traumatic condition and predicting fatality rate in department of emergency.Methods The chnical data of 27 706 traumatic patients in department of emergency were collected.The observation was categorized into three kinds：death within 24 h after reaching department of emergency （24 h death）;death from 24 h after reaching department of emergency to 7 d （death after 24 h）;survival.On the basis of the trauma mechanism,GCS,age and systolic pressure score （MGAP）,the GAP method was used for judging traumatic condition and predicting fatality rate of traumatic patients in department of emergency.The accuracy of GAP in predicting fatality rate was compared with revised trauma score （RTS）,trauma and injury severity score （TRISS） and MGAP.The C-statistics method was used to calculate the accuracy in predicted the fatality rate.Results The C values （0.936 and 0.961） of GAP in predicting fatality rate after 24 h and in 24 h were higher than RTS （0.917 and 0.958） and MGAP （0.920 and 0.950）,but slightly lower than TRISS （0.950 and 0.970）.The traumatic condition in GAP was defined in this way：severity 3-10 scores,moderation 11-18 scores,and slightness 19-24 scores.Conclusions The GAP is simple,practical and accurate in diagnosing patients＇ traumatic condition and predicting their fatality rate.It is helpful in physicians＇ decision of a proper treatment plan.

关 键 词：创伤严重度指数 创伤和损伤 病死率 

分 类 号：R459.7[医药卫生—急诊医学]