急诊创伤患者低体温风险评分量表的研制  

Construction of Hypothermia Risk Score for trauma patients admitted to emergency department

作　　者：陈天喜[1] 沈红五[2] 姜琴[1] 崔秋霞[1] 孙宏[1] 王伶俐 赵旭东 Chen Tianxi;Shen Hongwu;Jiang Qin;Cui Qiuxia;Sun Hong;Wang Lingli;Zhao Xudong(Emergency Department,Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院急诊科,江苏南通226001 [2]南通大学附属医院护理部,江苏南通226001

出　　处：《护理学杂志》2021年第23期38-41,共4页Journal of Nursing Science

基　　金：南通市科技计划资助项目(MSZ19176)。

摘　　要：目的研制急诊创伤患者低体温风险评分量表,验证其临床预测效果。方法选取489例急诊创伤患者作为建模组,根据是否出现低体温分为为低体温组和常温组,采用二元Logistic回归法分析影响创伤低体温的独立风险因素,构建创伤低体温风险评分量表,确定预测界值。再选取228例急诊创伤患者作为验证组,使用构建的量表预测评分,根据实际低体温的发生情况验证预测效果。结果建模组构建的创伤低体温风险评分量表包括4个条目:受伤环境温度≤8℃(1分),修正创伤评分<4分(2分),衣物潮湿(2分),入室时发生休克(2分)。验证组中低体温组患者和体温正常组患者风险评分量表评分差异具有统计学差异(P<0.01)。预测界值3分时,量表预测敏感度为0.709、特异度为0.920、阳性预测值为82.24%、阴性预测值为85.63%、总体正确率为86.08%,ROC曲线下面积为0.829[95%CI(0.769,0.888)]。结论构建的急诊创伤患者低体温风险评分量表具有良好的区分度和预测效果,可用于创伤患者低体温预测。Objective To preliminarily construct a Hypothermia Risk Score for traumatic patients admitted to emergency department,and verify its clinical predictive efficacy in clinical setting.Methods The clinical data of 489 trauma patients admitted to the emergency department were collected,and served as derivative group.According to the occurrence of hypothermia,the trauma patients were divided into a hypothermia group and a normothermia group.The independent risk factors influencing hypothermia in trauma patients were analyzed using multivariate logistic regression analysis,based on which,the Hypothermia Risk Score was constructed.Then the cut-off value of the instrument was determined using ROC curve.Additionally,another 228 trauma patients admitted to emergency department were selected as the validation group,who was assessed with the Hypothermia Risk Score,and the assessment results were compared with de facto occurrence of hypothermia.Results The Hypothermia Risk Score derived from the derivative group consisted of 4 items:environmental temperature≤8℃(scoring 1 point),RTS<4(scoring 2 points),damp clo-thing(scoring 2 points),and shock at admission(scoring 2 points).In the validation group,the assessment results of Hypothermia Risk Score had significant difference between the hypothermia subgroup and the normothermia group(P<0.01).At 3 points,the sensitivity,specificity,positive predictive value,negative predictive value of the instrument stood at 0.709,0.920,82.24%,and 85.63%respectively,with the overall correct rate of 86.08%,and the area under the ROC curve standing at 0.829[95%CI(0.769,0.888)].Conclusion The Hypothermia Risk Score has a high differentiation and predictive value.It can be used to identify trauma patients at high risk of hypothermia after trauma.

关 键 词：急诊 创伤 低体温 预测 风险评分 

分 类 号：R473.6[医药卫生—护理学] R641[医药卫生—临床医学]