基于决策树构建胸痛患者院内心脏骤停早期预警模型  

Decision tree model for predicting in-hospital cardiac arrest among chest pain patients

作　　者：龚海蓉[1] 吴婷婷 郑若菲[3] 李红[3] Gong Hairong;Wu Tingting;Zheng Ruofei;Li Hong(Nursing Faculty,Fujian Health College,Fuzhou 350101,China)

机构地区：[1]福建卫生职业技术学院护理学院,福建福州350101 [2]福建医科大学护理学院 [3]福建省立医院护理部

出　　处：《护理学杂志》2021年第14期23-28,共6页Journal of Nursing Science

基　　金：福建医科大学启航基金研究生创新项目(2020QH2016);福建卫生职业技术学院科研项目(2018-3-1)。

摘　　要：目的构建并验证基于决策树的胸痛患者院内心脏骤停早期预警模型。方法收集以急性非创伤性胸痛为主诉就诊并进入抢救室治疗的患者3146例,以其中发生心脏骤停的71例患者为病例组,选取同期未发生心脏骤停的142例患者为对照组,利用决策树构建心脏骤停早期预警模型,采用十折交叉进行验证,并与GRACE评分、TIMI评分和HEART评分比较模型的预测效能。结果决策树共有3层,5个节点,舒张压、Killip分级、肌钙蛋白、胸痛持续时间和肌酸激酶是心脏骤停的预测指标。基于决策树构建的模型受试者工作特征曲线下面积为0.893,显著高于TIMI评分(0.817)、HEART评分(0.801),差异有统计学意义(均P<0.05);高于GRACE评分(0.857),但差异无统计学意义(P>0.05)。结论基于决策树构建的胸痛患者院内心脏骤停早期预警模型对心脏骤停的预测准确性高、结果直观、逻辑清晰,可作为医护人员对胸痛患者风险管理的决策依据。Objective To develop and validate a decision tree model to identify in-hospital cardiac arrest among chest pain patients at the emergency department.Methods Data of 3146 patients who complained of nontraumatic acute chest pain and rescued in the emergency department were collected.Seventy-one patients experienced cardiac arrest were treated as the case group,and 142 patients without cardiac arrest were treated as the control group.Decision tree analysis was performed to determine the early warning system of cardiac arrest,and 10-fold cross validation was used to verify.Performance of the decision tree model was compared with the GRACE,TIMI and HEART scores.Results The decision tree included three layers and five nodes of diastolic blood pressure,Killip class,troponin I,duration of chest pain,and creatine kinase.The area under the ROC curve of the decision tree model was 0.893,which was significantly higher than TIMI score(0.817)and HEART score(0.801)(P<0.05 for both),and was also higher than GRACE score(0.857)but without significant difference(P>0.05).Conclusion The decision tree model with good accuracy,intuitive results,and clear logic in predicting cardiac arrest can be used as a decision-making reference for medical staff on risk management of chest pain.

关 键 词：胸痛 风险预测 急性冠脉综合征 心脏骤停 决策树 GRACE评分 TIMI评分 HEART评分 

分 类 号：R473.5[医药卫生—护理学]