急救系统风险预测模型和改良早期预警评分预测急诊危重患者短期病死率的比较研究  

Comparison between DAVROS and MEWS in predicting short-term mortality of critically ill patients in emergency department

作　　者：付源伟 梁杨[1] 葛洪霞[1] 翟樯榕 李楠[1] 马青变[1] Fu Yuan-wei;Liang Yang;Ge Hong-xia;Zhai Qiang-rong;Li Nan;Ma Qing-bian(Emergency Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中国急救医学》2020年第10期922-925,共4页Chinese Journal of Critical Care Medicine

基　　金：北京大学医学部密西根项目(BMU20160561)。

摘　　要：目的探讨急救系统风险预测模型(development and validation of risk-adjusted outcomes for systems of emergency medical care,DAVROS)和改良早期预警评分(modified early warning score,MEWS)对急诊危重患者短期病死率的预测价值,并进行比较研究.方法对急诊抢救室1143例危重患者进行DAVROS评分和MEWS评分,以入抢救室后7日病死率作为研究终点,比较两种评分模型预测患者短期死亡风险的准确性.结果入抢救室患者中,循环系统疾病占比为35.3%,7日内实际病死率为15.5%.生存组和死亡组患者主要病理生理学数据间差异有统计学意义.死亡组DAVROS评分[3.39(0.94~10.79)vs.0.58(0.24~1.41)]、MEWS评分[4.00(3.00~6.00)vs.2.00(1.00~4.00)]和DAVROS评分预测患者7日病死率77.2%[(48.9%~91.5%)vs.36.7%(19.4%~58.4%)]高于生存组,差异均有统计学意义(P<0.001).DAVROS评分和MEWS评分预测患者短期死亡风险的ROC曲线下面积分别为0.774(95%CI0.736~0.812)和0.723(95%CI0.683~0.763),两者差异有统计学意义(Z=2.591,P=0.0096).结论DAVROS评分用于预测急诊危重患者短期病死率的准确性优于MEWS评分,两者联合预测急诊患者死亡风险的准确性尚需进一步研究证实.Objective To compare the value of development and validation of risk-adjusted outcomes for systems of emergency medical care(DAVROS)and modified early warning score(MEWS)in predicting short-term mortality of critically ill patients in emergency department.Methods DAVROS scores and MEWS scores were recorded for 1143 critically ill patients in the emergency room.The study endpoint was 7-day mortality after admission.The accuracy of the two scores in predicting short-term death risk was compared.Results In all cases admitted into emergency room,the proportion of circulatory diseases was 35.3%,and the actual mortality within 7 days was 15.5%.There were significant differences in the main pathophysiological data between the survival group and the death group.The MEWS score was 4.00(3.00-6.00),DAVROS score was 3.39(0.94-10.79),and 7-day mortality predicted by DAVROS was 77.2%(48.9%-91.5%)in death group,which were higher than those[2.00(1.00-4.00),0.58(0.24-1.41)and 36.7%(19.4%-58.4%)]in survival group,and there were significant differences(P<0.001).The area under the ROC curve of DAVROS score and MEWS score in predicting short-term death risk of patients were 0.774(95%CI 0.736-0.812)and 0.723(95%CI 0.683-0.763),which were significantly different(Z=2.591,P=0.0096).Conclusion DAVROS is more accurate than MEWS in predicting short-term mortality of critically ill patients in the emergency department,and more research is needed to assess the possibility of combining the two scores in predicting the risk of death in emergency critical patients.

关 键 词：急救系统风险预测模型(DAVROS) 改良早期预警评分(MEWS) 急诊危重患者 短期病死率 

分 类 号：R459.7[医药卫生—急诊医学]