3种急诊预检分诊标准分诊效果的Meta分析  

Triage effect of three emergency pre⁃examination triage standard:a Meta⁃analysis

作　　者：谢丹[1] 余璐璐 涂小朋[1] 李欢[1] 田钰[1] XIE Dan;YU Lulu;TU Xiaopeng;LI Huan;TIAN Yu(Zhongnan Hospital of Wuhan University,Hubei 430071 China)

机构地区：[1]武汉大学中南医院,湖北430071

出　　处：《护理研究》2020年第18期3239-3249,共11页Chinese Nursing Research

摘　　要：[目的]评价曼彻斯特分诊量表(MTS)、急诊危重指数(ESI)和加拿大急诊预检标尺系统(CTAS)的分诊效果。[方法]检索PubMed、the Cochrance Library、EMbase、Web of Science、中国生物医学文献数据库、维普数据库、万方数据库、中国知网(CNKI),收集关于急诊预检分诊标准MTS、ESI、CTAS的分诊效果研究,检索时限均为数据库建立至2019年8月31日。由2名研究者独立完成文献筛选、数据提取。采用双变量混合效应模型合并急诊预检分诊标准分诊效果的敏感度、特异度和诊断比值比(DOR);敏感度和特异度用于构建受试者工作特征曲线(ROC),ROC曲线下面积(AUC)用于评价各急诊预检分诊标准的分诊效果;采用Deek漏斗图评价文献发表偏倚;采用范根图评价分诊系统的临床适用性。[结果]共纳入35项研究,总体Meta分析结果显示:MTS合并的敏感度为0.57,95%CI(0.49,0.65),P=0.00;特异度为0.84,95%CI(0.80,0.87),P=0.00;DOR为6.94,95%CI(5.08,9.48),P=0.00;AUC为0.80,95%CI(0.76,0.83)。ESI合并的敏感度为0.50,95%CI(0.38,0.62),P=0.00;特异度为0.87,95%CI(0.82,0.91),P=0.00;DOR为6.84,95%CI(5.21,8.98),P=0.00;AUC为0.80,95%CI(0.77,0.84)。CTAS合并的敏感度为0.35,95%CI(0.29,0.43),P=0.00;特异度为0.92,95%CI(0.88,0.94),P=0.00;DOR为5.98,95%CI(4.31,8.29),P=0.00;AUC为0.72,95%CI(0.68,0.76)。敏感性分析证明研究结果较为稳定,各项研究无明显偏倚,3个急诊预检分诊标准存在明显异质性。亚组分析显示:3个急诊预检分诊标准的异质性主要来源于人群。范根图总体分析显示:3个分诊标准评估阳性时,受试者需要住院的概率上升。[结论]现有证据表明,运用MTS和ESI对急诊病人进行预检分诊的总体准确性较好,但诊断效能有待进一步提高。Objective:To evaluate triage effects of Manchester Triage Scale(MTS),Emergency Severity Index(ESI),Canadian Triage and Acuity Scale(CTAS).Methods:PubMed,the Cochrance Library,EMbase,Web of Science,Chinese Biomedical Literature Database,VIP Database,Wanfang Database,CNKI were systematically searched.And researches on triage effects of emergency pre⁃examination triage standards,like MTS,ESI and CTAS were collected.The retrieval time was from inception to August 31,2019.Literatures screening and data extraction were carried out by two researchers,independently.Sensitivity,specificity and diagnostic odds ratio(DOR)of triage effect of emergency pre⁃examination triage standards were combined by adpoting bivariate mixed effects model.Sensitivity and specificity were used to construct receiver operating characteristic curve(ROC).And the area under ROC curve(AUC)was used to evaluate triage effect of each emergency pre⁃examination triage standard.Deek funnel was used to evaluate publication bias.Fan Gen chart was used to evaluate clinical applicability of triage standards.Results:A total of 35 studies were included.Overall Meta analysis results showed that combined sensitivity of MTS was 0.57,95%CI(0.49,0.65),P=0.00.Specificity of MTS was 0.84,95%CI(0.80,0.87),P=0.00.DOR was 6.94,95%CI(5.08,9.48),P=0.00.AUC was 0.80,95%CI(0.76,0.83).The combined sensitivity of ESI was 0.50,95%CI(0.38,0.62),P=0.00.Specificity was 0.87,95%CI(0.82,0.91),P=0.00.DOR was 6.84,95%CI(5.21,8.98),P=0.00.AUC was 0.80,95%CI(0.77,0.84).The combined sensitivity of CTAS was 0.35,95%CI(0.29,0.43),P=0.00.Its specificity was 0.92,95%CI(0.88,0.94),P=0.00.DOR was 5.98,95%CI(4.31,8.29),P=0.00.AUC was 0.72,95%CI(0.68,0.76).Sensitivity analysis verified that research results were relatively stable.There was no obvious bias in each study.There were obvious heterogeneity in three emergency pre⁃examination triage standards.Subgroup analysis showed that populations were main source of heterogeneity among three emergency pre⁃examination triage standards.The

关 键 词：急诊科 预检分诊 曼彻斯特分诊量表 急诊危重指数 加拿大急诊预检标尺系统 META分析 系统评价 

分 类 号：R47[医药卫生—护理学]