2种评分对观察室患者非计划性转抢救室的预测价值  

Value of two score systems for unplanned transfer of patients from emergency observation room to emergency room

作　　者：于敏 曹云 邱家雯 周娟 何斌 郝卫文 YU Min;CAO Yun;QIU Jiawen;ZHOU Juan;HE Bin;HAO Weiwen(Center for Emergency Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029)

机构地区：[1]南京医科大学第一附属医院急诊医学中心,江苏南京210029

出　　处：《实用临床医药杂志》2022年第22期48-51,共4页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生健康委员会面上项目(H2019108)。

摘　　要：目的比较改良早期预警评分(MEWS)与国家早期预警评分(NEWS)对急诊观察室患者非计划性转抢救室的预测效果。方法回顾性分析急诊观察室333例患者的临床资料,其中非计划性转抢救室患者47例。47例转抢救室患者中,将37例NEWS≥3分患者设为NEWS异常组,24例MEWS≥2分的患者设为MEWS异常组。记录患者一般资料、MEWS、NEWS以及转抢救室时重要器官恶化情况。留观72 h后,根据患者转归情况绘制受试者工作特征(ROC)曲线,比较2种评分对非计划转抢救室的预测价值,并进一步分析2种评分对重要器官恶化预测价值的差异。结果2组患者年龄、白蛋白水平、MEWS和NEWS比较,差异有统计学意义(P<0.05)。ROC曲线结果显示,NEWS的曲线下面积(AUC)为0.86,最佳截断值为3分,敏感度为0.83,特异度为0.77。MEWS的AUC为0.78,最佳截断值为2分,敏感度为0.77,特异度为0.75。2种评分预测患者非计划性转入抢救室的AUC比较,差异有统计学意义(Z=2.03,P=0.04)。2组呼吸衰竭患者占比比较,差异有统计学意义(P<0.05)。结论与MEWS相比,NEWS预测急诊观察室患者非计划性转抢救室具有较高的价值,优势可能来自对呼吸衰竭的预测。Objective To compare the predictive effect of the Modified Early Warning Score(MEWS)and the National Early Warning Score(NEWS)on the unplanned transfer of patients from emergency observation room to emergency room.Methods A retrospective analysis was performed for 333 patients in the emergency observation room,including 47 cases who were unplanned transferred to the emergency room.Among 47 patients transferred to the emergency room,37 patients with NEWS≥3 were included in abnormal NEWS group,and 24 patients with MEWS≥2 were included in abnormal MEWS group.General data,MEWS,NEWS and deterioration condition of vital organs during transfer to the emergency room were recorded.After 72 h of observation,receiver operating characteristic(ROC)curve was drawn according to the outcome of patients,and the predictive value of the two scoring systems for unplanned transfer from emergency observation room to emergency room was compared,and the difference of the predictive value of the two scoring systems for the deterioration of vital organs was further analyzed.Results There were statistically significant differences in age,albumin level,MEWS and NEWS between two groups(P<0.05).ROC curve results showed that the area under the curve(AUC)of NEWS was 0.86,the optimum cut-off value scored 3,the sensitivity was 0.83,and the specificity was 0.77.AUC of MEWS was 0.78,the optimum cut-off value scored 2,the sensitivity was 0.77,and the specificity was 0.75.AUC of two scoring systems in predicting unplanned transfer to the emergency room was compared,and the difference was statistically significant(Z=2.03,P=0.04).There was statistical significance in the proportion of respiratory failure patients between the two groups(P<0.05).Conclusion Compared with MEWS,NEWS has a higher value in predicting unplanned transfer from emergency observation room to emergency room,and its advantage may be based on the prediction of respiratory failure.

关 键 词：急诊观察室 改良早期预警评分 国家早期预警评分 非计划性 抢救室 预测价值 

分 类 号：R459.7[医药卫生—急诊医学] R3[医药卫生—治疗学]