MEWS和NEWS对急诊高龄跌倒患者伤情评估效果的比较研究  

Comparative study of MEWS and NEWS on injury assessment of elderly fall patients in emergency department

作　　者：侯兰[1] 龚竹云[1] 卢晓兰[1] 尹明[1] 邵红艳[1] 赵诺[2] Hou Lan;Gong Zhuyun;Lu Xiaolan;Zhao Nuo(Department of Emergency,the Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心门诊部急诊医学科、国家老年疾病临床研究中心,北京100853 [2]解放军总医院第三医学中心护理部

出　　处：《中华保健医学杂志》2022年第6期495-497,共3页Chinese Journal of Health Care and Medicine

基　　金：北京市海淀区卫生健康发展科研培育计划(HP2021-98-80301)。

摘　　要：目的探讨改良早期预警评分(MEWS)和国家早期预警评分(NEWS)对急诊高龄男性患者跌倒造成伤情评估效果差异。方法选取解放军总医院第二医学中心急诊医学科2018年1月~2021年12月因跌倒急诊就诊的362例高龄男性跌倒患者,采用MEWS、NEWS同时对患者进行评估,并根据患者跌倒后伤害级别分组。比较两种评分方法在不同分组患者中的差异,使用ROC曲线比较两种评分对高龄男性跌倒患者病情变化的辨识能力。结果不同伤害级别的跌倒患者MEWS、NEWS分值差异有统计学意义(P<0.01),MEWS、NEWS得分均随病情严重程度而增高,与NEWS、MEWS得分Spearman秩相关系数分别为0.7699和0.7317;Ⅱ级伤害组NEWS的最佳截断值为4.5分,敏感度为92.6%,特异度为99.6%,曲线下面积为(0.9755±0.0125);MEWS最佳截点为2.5分,敏感度为55.6%,特异度为91.0%,曲线下面积为(0.7493±0.0442),曲线下面积比较,差异有统计学意义(Z=4.9280,P<0.01)。Ⅲ级伤害组NEWS的最佳截断值为5.0分,敏感度为100%,特异度为99.6%,曲线下面积为(0.9990±0.0011);MEWS最佳截点为2.5分,敏感度为100%,特异度为91.0%,曲线下面积为(0.9985±0.0058),曲线下面积比较,差异没有统计学意义(Z=0.0875,P>0.05)。结论与MEWS比较,NEWS可更准确地对高龄男性患者跌倒的病情严重程度进行早期评估。Objective To investigate the difference between modified early Warning Score(MEWS)and National Early Warning Score(NEWS)in the assessment of falls in elderly male patients in emergency department.Methods A total of 362 elderly male patients who visited the emergency department for falls in a hospital from January 2018 to December 2021 were selected as the study subjects.The patients were evaluated by MEWS and NEWS at the same time,and were grouped according to the injury level after falls.To compare the differences of the two scoring methods in different groups of patients,ROC curve was used to compare the prediction ability of the two scoring methods for the disease change of elderly male fall patients.Results There were statistically significant differences in MEWS and NEWS scores among patients with different injury levels(P<0.001),and both MEWS and NEWS scores increased with the severity of the disease.Spearman rank correlation coefficients with NEWS and MEWS scores were0.7699 and 0.7317(P<0.0001),respectively.The optimal cut-off value,sensitivity,specificity and area under curve of NEWS in gradeⅱinjury group were 4.5 points,92.6%,99.6%and(0.9755±0.0125)respectively.The optimum MEWS cut-off point was 2.5points,the sensitivity was 55.6%,the specificity was 91.0%,and the area under the curve was(0.7493±0.0442).The difference was statistically significant(Z=4.9280,P<0.01).The optimum cut-off value,sensitivity,specificity and area under curve of NEWS in gradeⅲinjury group were 5.0 points,100%,99.6%and(0.9990±0.0011)respectively.The optimum MEWS cut-off point was 2.5points,the sensitivity was 100%,the specificity was 91.0%,and the area under the curve was(0.9985±0.0058).There was no statistically significant difference in the area under the curve(Z=0.0875,P>0.05).Conclusion Compared with MEWS,NEWS is more accurate for early assessment of fall severity in elderly male patients.

关 键 词：改良早期预警评分 国家早期预警评分 高龄 跌倒 伤情评估 

分 类 号：R592[医药卫生—老年医学]