急诊发热患者预检分诊危重指标探讨  

Preliminary study on critical indicators of pre-examination triage in emergency fever patients

作　　者：田丽源[1] 李凡[1] 朱华栋[1] 刘晓颖[1] 任伟[1] 贾铮[1] 王静怡[1] 刘爱辉[1] 徐军[1] Tian Li-yuan;Li Fan;Zhu Hua-dong;Liu Xiao-ying;Ren Wei;Jia Zheng;Wang Jing-yi;Liu Ai-hui;Xu Jun(Emergency Department,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]北京协和医院急诊科,北京100730

出　　处：《中国急救医学》2022年第2期137-141,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨急诊发热患者预检分诊有效的危重指标,以精准识别其危重程度,保障患者安全,提高患者就医体验。方法回顾性收集2019年3月至2019年5月北京协和医院939例急诊发热患者的临床客观指标,包括性别、年龄、生命体征、改良早期预警评分(MEWS)、休克指数、修正休克指数、医疗资源等,分析患者各项临床指标对生存状态的影响,并应用Logistic回归分析得出其危重程度独立危险因素。应用受试者工作特征(ROC)曲线得出预测急诊发热患者预检分诊危重程度指标及最佳截断值。结果939例急诊发热患者中,死亡21例,占2.24%,死亡组和存活组年龄、创伤警觉量表(AVPU)评分、体温、心率、呼吸、血氧饱和度、MEWS得分、休克指数、修正休克指数、医疗资源使用数目等10项临床指标比较差异有统计学意义(P<0.05);将急诊发热患者年龄、AVPU评分、体温、心率、呼吸、血氧饱和度纳入多因素Logistic回归分析并构建方程,得出AUC为0.974(0.952~0.997),敏感度90.5%,特异度93.9%,最佳截断值为0.020。ROC曲线预测急诊发热患者危重程度有效参数有年龄、体温、心率、呼吸、血氧饱和度,最佳截断值分别为46.0岁、39.0℃、129.0次/min、25.0次/min、79.0%。评分系统中,MEWS得分AUC最高,为0.910(0.850~0.970),最佳截断值为7.0分。结论生命体征客观指标结合年龄可构成急诊发热患者预检分诊危重程度预测的独立危险因素,对急诊预检分诊发现潜在危重症患者具有临床指导意义。Objective To explore the effective critical indicators of pre-examination triage for emergency febrile patients,so as to accurately identify the critical degree,ensure the safety of patients and improve the medical experience of patients.Methods Objective clinical indicators of 939 patients with fever in emergency department of our hospital from March to May in 2019 were collected retrospectively,including gender,age,vital signs,modified early warning score(MEWS),shock index,modified shock index,medical resources,etc.The differences of clinical indicators for the survival status of patients were analyzed,and the independent risk factors of severity were obtained by Logistic regression analysis.ROC curve was used to get the critical degree index and the best cut-off value.Results Among the 939 patients with fever in emergency department,21 patients died,accounting for 2.24%.Among them,10 clinical indicators,such as age,alert,verbal,pain,unresponsive(AVPU)score,body temperature,heart rate,respiration,oxygen saturation,MEWS score,shock index,modified shock index and the number of medical resources used,had statistical differences between the survival group and the death group(P<0.05);The age,AVPU score,body temperature,heart rate,respiration and blood oxygen saturation of emergency febrile patients were included in the multivariate Logistic regression analysis,and the equation was constructed.The AUC was 0.974(0.952-0.997),the sensitivity was 90.5%and the specificity was 93.9%,and the best cutoff value was 0.020.The effective parameters of ROC curve for predicting critical severity included age,body temperature,heart rate,respiration and oxygen saturation,the best cut-off values were 46.0 years old,39.0℃,129.0 beats per minute,25.0 beats per minute and 79.0%respectively.In the scoring system,the AUC of MEWS was the highest,which was 0.910(0.850-0.970),and the best cut-off value was 7.0.Conclusions The objective index of vital signs combined with the patient′s age can constitute an independent risk factor for eme

关 键 词：发热患者 预检分诊 危重 

分 类 号：R459.7[医药卫生—急诊医学]