MEWS SCS和CRBP评分对急诊抢救患者预后评估价值的比较研究  

Three different scoring methods in predicting outcomes in patients of internal emergency room

作　　者：易含笑 杨珍[1] 张敏 王水连 张华建 邝钰贤 Yi Han-xiao;Yang Zhen;Zhang Min;Wang Shui-lian;Zhang Hua-jian;Kuang Yu-xian(The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院,江西南昌330006

出　　处：《中国急救医学》2019年第10期935-938,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨改良早期预警评分(modified early warning score,MEWS)、简单临床评分(simple clinical score,SCS)及生命体征评估法(CRBP评分)对急诊抢救患者病情和预后评估的应用价值,并进行对比研究.方法对急诊抢救室1176例患者进行MEWS评分、SCS评分和CRBP评分,根据预后分为存活组和死亡组,比较两组MEWS评分、SCS评分和CRBP评分与急诊抢救患者预后的相关性;同时应用ROC曲线下面积比较三种评分对死亡和入住重症监护病房(ICU)的评估价值.结果存活组的MEWS评分(2.61±1.68)分、SCS评分(6.72±2.81)分和CRBP评分(1.33±0.48)分,分别低于死亡组MEWS评分(6.92±1.85)分、SCS评分(11.58±2.41)分和CRBP评分(2.68±0.96)分,差异有统计学意义(P=0.000);MEWS评分、SCS评分和CRBP评分预测入住ICU的ROC曲线下面积分别为0.758、0.716和0.702(P<0.0001),预测死亡的ROC曲线下面积分别为0.947、0.906和0.866(P<0.0001).MEWS评分预测入住ICU的ROC曲线下面积与SCS评分比较差异有统计学意义(P=0.0073),与CRBP评分比较差异有统计学意义(P=0.0005),SCS评分与CRBP评分差异无统计学意义(P=0.4876);MEWS评分预测死亡的ROC曲线下面积与SCS评分比较差异有统计学意义(P<0.001),与CRBP评分比较差异有统计学意义(P=0.0014),SCS评分与CRBP评分比较差异无统计学意义(P=0.0997).结论MEWS、SCS和CRBP评分均能预测预后,其预测准确度为MEWS高于SCS高于CRBP;从临床实践考虑,MEWS评分联合CRBP评分更适合急诊抢救室的病情评估.Objective To study the assessment value of modified early warning score(MEWS),simple clinical score(SCS)and CRBP evaluation method on the prognosis of critical patients of internal emergency room.Methods MEWS score,SCS score and CRBP score were performed on 1176 patients in emergency room.The patients were divided into survival and death groups according to the outcomes,comparing the correlation between MEWS score,SCS score and CRBP score and the prognosis of emergency rescue patients.The area under the ROC curve was used to evaluate the value of these three scores in predicting patient death and intensive care unit admission.Results The MEWS was(2.61±1.68),SCS was(6.72±2.81)and CRBP was(1.33±0.48)in survival group;in deah group,the three scores were(6.92±1.85),(11.58±2.41)and(2.68±0.96),respectively;these scores were higher than those in survival group.The area under ROC curve of predicting patient ICU admission of MEWS,SCS and CRBP score were 0.758,0.716 and 0.702,respectively(P<0.0001).The area under the ROC curve of predicting patient death of MEWS,SCS and CRBP scores were 0.947,0.906 and 0.866(P<0.0001).The difference in area under the ROC curve of the ICU between MEWS and SCS score was significant(P=0.0073).The difference in area under the ROC curve of the ICU between MEWS and CRBP score was significant(P=0.0005),while there was no significant difference in area under the ROC curve of the ICU between SCS and CRBP(P=0.4876).The difference in area under the ROC curve of patients with death between MEWS and SCS score was significant(P<0.001).The difference in area under the ROC curve of patients with death between MEWS and CRBP score was significant(P=0.0014),while there was no significant difference in area under the ROC curve of patients with death between SCS and CRBP(P=0.0997).Conclusion The three different score systems were useful in predicting outcomes of severe patients,and the MEWS combined with the CRBP score is more suitable for the emergency assessment system of the emergency room.

关 键 词：急诊室 改良早期预警评分(MEWS) 简单临床评分(SCS) 生命体征评分(CRBP) 预后 

分 类 号：R47[医药卫生—护理学]