4种评分系统评估院前急救患者病情及预后的价值的比较研究
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摘要
目的:比较改良早期预警评分(MEWS)、全身炎症反应综合征评分(SIRS)、简单临床评分(SCS)、快速急诊内科评分(REMS)评估院前急救患者病情及预后的价值。方法:对我院实施院前急救的685例急诊患者分别进行MEWS评分、REMS评分、SCS评分和SIRS评分,追踪患者的预后,并以当次入院病死率为根据,比较4种评分系统不同分值段的病死率差异,通过ROC曲线下面积比较4种评分系统评估院前急救患者病情及预后的准确性。结果:存活与死亡患者的MEWS评分、REMS评分、SCS评分和SIRS评分比较差异均具有统计学意义(P<0.05)。MEWS评分、REMS评分、SCS评分和SIRS评分的分值越高,病死率越高,各分值段间病死率比较差异均具有统计学意义(x~2=72.60、82.31、151.94、72.49,P均<0.05);MEWS评分、REMS评分、SCS评分和SIRS评分的ROC曲线下面积分别为0.765、0.758、0.829和0.695,以SCS评分的ROC曲线下面积最大。结论:MEWS评分、REMS评分、SCS评分和SIRS评分均能对院前急诊患者的病死率进行预测,准确度SCS>MEWS>REMS>SIRS,SCS评分更能准确地对院前急救患者进行早期预后评估。
Objective:To compare the accuracy of four scoring systems:modified early warning score(MEWS),rapid emergency medical score(REMS),simple clinical score(SCS) and systemic inflammatory response syndrome(SIRS) on evaluating the severity and prognosis of pre-hospital emergency patients.Methods:MEWS,REMS,SCS and SIRS scores were performed on 685 pre-hospital emergency patients.The patients were followed-up until they discharged or died in the hospital.The accuracies of four scoring systems on assessing the severity and prognosis of the emergency patients were compared by the area under receiver operating characteristic(ROC) curve.Results:There were significant differences in MEWS,REMS,SCS and SIRS scores between survival and the dead(P<0.05).The higher the MEWS,REMS,SCS and SIRS score(x~2=72.60,82.31,151.94 and 72.49,all P<0.05),the higher the mortality.The areas under the ROC curve of MEWS,REMS,SCS and SIRS scores were 0.765,0.758,0.829 and 0.695,respectively,and the largest one was SCS.Conclusions:All the MEWS,REMS,SCS and SIRS scores can be used to predict the mortality of pre-hospital emergency patients.The accuracy shows SCS> MEWS> REMS> SIRS,and SCS is more accurate for evaluating the early prognosis of pre-hospital emergency patients.
Objective:To compare the accuracy of four scoring systems:modified early warning score(MEWS),rapid emergency medical score(REMS),simple clinical score(SCS) and systemic inflammatory response syndrome(SIRS) on evaluating the severity and prognosis of pre-hospital emergency patients.Methods:MEWS,REMS,SCS and SIRS scores were performed on 685 pre-hospital emergency patients.The patients were followed-up until they discharged or died in the hospital.The accuracies of four scoring systems on assessing the severity and prognosis of the emergency patients were compared by the area under receiver operating characteristic(ROC) curve.Results:There were significant differences in MEWS,REMS,SCS and SIRS scores between survival and the dead(P<0.05).The higher the MEWS,REMS,SCS and SIRS score(x~2=72.60,82.31,151.94 and 72.49,all P<0.05),the higher the mortality.The areas under the ROC curve of MEWS,REMS,SCS and SIRS scores were 0.765,0.758,0.829 and 0.695,respectively,and the largest one was SCS.Conclusions:All the MEWS,REMS,SCS and SIRS scores can be used to predict the mortality of pre-hospital emergency patients.The accuracy shows SCS> MEWS> REMS> SIRS,and SCS is more accurate for evaluating the early prognosis of pre-hospital emergency patients.
引文
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[11]王伟力,田丽,王瑛.MEWS、REMS、APACHEⅡ、SAPSⅡ4种评分系统在老年危重患者中的相关性研究及对预后的评估[J].临床荟萃,2015,30(3):253-256.
[12]孙宝迪,邵旦兵,刘红梅.MEWS评分和SIRS评分评估急诊抢救室患者早期预后的对比研究[J].中国急救医学,2012,32(1):54-57.
[13]任艺,邵旦兵,刘红梅,等.SCS评分、SIRS评分和APACHEⅡ评分在急诊危重患者预后评估中的比较研究[J].临床误诊误治,2014,27(1):1-4.
[14]朱睿瑶,姚兰,夏文芳,等.MEWS评分和APACHEⅡ评分在多发伤患者预后评估中的比较研究[J].中华临床医师杂志(电子版),2013,7(24):11392-11395.
[15]邓腊明,周航亮.四种评分体系用于临床急诊评估危重患者的预后价值对比研究[J].现代实用医学,2015,27(4):511-513,558.
[2]王秋萍.改良早期预警评分在院前急救患者病情评估中的应用[J].齐鲁护理杂志,2016,22(15):111-112.
[3]谢宜,黄敬彬,苏奕强,等.改良早期预警评分在院前急救中对患者病情评诂的应用研究[J].中国社区医师,2012,14(11):192-194.
[4]陈娇,钱晓明,任艺,等.MEWS评分、SIRS评分和APACHEⅡ评分对急诊颅脑外伤患者预后评估的对比研究[J].临床急诊杂志,2013,14(11):528-531.
[5]任艺,邵旦兵,刘红梅.简单临床评分在急诊抢救室中的应用价值[J].中华急诊医学杂志,2012,21(9):1012-1015.
[6]李亮,任艺,邵旦兵,等.SIRS评分、REMS评分和APACHEⅡ评分在急诊危重患者预后评估中的对比研究[J].临床急诊杂志,2014,15(5):248-250.
[7]常亮,申浩,李文放,等.2种评分标准对急诊潜在危重病患者病情评估及预后分析的比较[J].实用临床医药杂志,2013,17(7):36-38.
[8]阮海林,杨春旭,黄福文,等.改良早期预警评分对评估院前急救患者病情及预后的价值[J].山东医药,2011,51(21):97-98.
[9]刘静波,黄萍.MEWS评分和APACHEⅡ评分对急诊老年危重症患者预后的评估[J].医学综述,2013,19(8):1491-1493.
[10]Recknagel S,Bindl R,Wehner T,et al.Conversion from external fixator to intramedullary nail causes a second hit and impairs fracture healing in a severe trauma model[J].J Orthop Res,2013,31(3):465-471.
[11]王伟力,田丽,王瑛.MEWS、REMS、APACHEⅡ、SAPSⅡ4种评分系统在老年危重患者中的相关性研究及对预后的评估[J].临床荟萃,2015,30(3):253-256.
[12]孙宝迪,邵旦兵,刘红梅.MEWS评分和SIRS评分评估急诊抢救室患者早期预后的对比研究[J].中国急救医学,2012,32(1):54-57.
[13]任艺,邵旦兵,刘红梅,等.SCS评分、SIRS评分和APACHEⅡ评分在急诊危重患者预后评估中的比较研究[J].临床误诊误治,2014,27(1):1-4.
[14]朱睿瑶,姚兰,夏文芳,等.MEWS评分和APACHEⅡ评分在多发伤患者预后评估中的比较研究[J].中华临床医师杂志(电子版),2013,7(24):11392-11395.
[15]邓腊明,周航亮.四种评分体系用于临床急诊评估危重患者的预后价值对比研究[J].现代实用医学,2015,27(4):511-513,558.