基于改良早期预警评分构建神经重症患者院内转运风险评估工具  

Based on the modified early warning score constructing a risk assessment tool for hospital transportation of neurocritical patients

作　　者：朱秀丽 廖常菊 陈杨[3] 毛世芳 ZHU Xiuli;LIAO Changju;CHEN Yang;MAO Shifang(School of Nursing,Southwest Medical University,Sichuan Province,Luzhou 646000,China;Department of Nursing Administration,Zigong First People's Hospital,Sichuan Province,Zigong 643000,China;Neurocritical Care Unit,Zigong First People's Hospital,Sichuan Province,Zigong 643000,China;Department of Nursing Administration,the Affiliated Hospital,Southwest Medical University,Sichuan Province,Luzhou 646000,China)

机构地区：[1]西南医科大学护理学院,四川泸州646000 [2]四川省自贡市第一人民医院护理部,四川自贡643000 [3]四川省自贡市第一人民医院神经重症监护病房,四川自贡643000 [4]西南医科大学附属医院护理部,四川泸州646000

出　　处：《中国当代医药》2024年第28期9-15,共7页China Modern Medicine

基　　金：四川省自贡市哲学社会科学重点研究基地患者安全研究中心课题(HZAQ-2022-03)。

摘　　要：目的基于改良早期预警评分(MEWS)构建神经重症患者院内转运风险评估工具,并评价其信效度和诊断界值。方法基于MEWS评估框架结合文献研究、小组讨论、半结构访谈构建评估工具初始条目,并进行两轮德尔菲专家咨询。2022年7月至12月,采用便利抽样法选取四川省自贡市第一人民医院的281例神经重症患者进行临床观察,通过项目区分度、信度分析、探索性因子分析检验评估工具的信效度,绘制ROC曲线确定评估工具的诊断界值。结果神经重症患者院内转运风险评估工具包括4个维度、13个条目、51项评分细则,累积方差贡献率为76.03%。评估工具的模型适配度良好,评估工具的总体Cronbach's α为0.831,内容效度指数为0.926。ROC曲线下面积为0.827,约登指数最大值对应分值为9.5分,即9.5分及以上者存在院内转运风险。结论神经重症患者院内转运风险评估工具具有良好的信效度,值得临床推广应用。Objective Based on the modified early warning score(MEWS)constructing a risk assessment tool for hospital transportation of neurocritical patients and evaluating its reliability and diagnostic thresholds.Methods The initial entries of the assessment tool were constructed based on the MEWS framework by literature research,group discussions,semi-structured interviews,and two rounds of Delphi expert consultation.From July to December 2022,281 neurocritical patients from Zigong First People's Hospital were recruited by convenience sampling method for observation.The reliability and validity of the assessment tool were examined by item differentiation,reliability analysis,and exploratory factor analysis,and the diagnostic thresholds of the assessment tool were determined by plotting ROC curves.Results The risk assessment tool for hospital transportation of neurocritical patient included 4 dimensions,13 entries,and 51 scoring details,with a cumulative variance contribution of 76.03%.The model fits well,with an overall Cronbach's α of 0.831,and a content validity index of 0.926.the area under the ROC curve was 0.827,and the maximum value of the Youden index corresponded to a score of 9.5,indicating that patients with a score of 9.5 and above were at risk of in-hospital transfer.Conclusion The risk assessment tool for hospital transportation of neurocritical patient has good reliability and validity,it is worthy of clinical application.

关 键 词：神经重症患者 院内转运 改良早期预警评分 风险评估 评估工具 

分 类 号：R741[医药卫生—神经病学与精神病学]