摘要
目的研究改良早期预警评分（MEWS）系统在院前创伤患者病情评估和死亡预测的价值及可行性。方法以广西医科大学第四附属医院2010年1月1日至2010年12月31日院前创伤患者作为研究对象，现场采集相关数据，进行MEWS评分，以收入院后90d为观察终点，结局作为观察指标，计数资料以百分比表示，用x。检验，计量资料以均数±标准差（面±s）表示，用成组￡检验，以P〈0．05为差异具有统计学意义。对患者进行MEWS评分工作特征曲线（ROC曲线）下面积计算，计算患者相应的预测指标。本研究对象不包括院前无生命体征且复苏无效的伤者。结果0～2分的患者1475例次，占87．95％，3～13分共202例次，占12．05％；死亡组MEWS评分较存活组高，差异具有统计学意义（P〈0．01）；MEWS评分ROC曲线下面积为0．944，判断院前创伤患者“潜在危重症”的最佳截断点为≥3分，对危重症患者死亡预测的敏感度86．7％，特异度为88．6％，准确度为88．6％，约登指数为0．753。表明MEWS评分在创伤患者病情评估及死亡的预测具有较强的应用价值。结论MEWS评分对院前创伤患者病情评估及死亡的预测具有较高的分辨能力，此评分方法为简单、实用、可操作性强，有较强的应用价值。
Objective To study the feasibility of modified early warning scores （MEWS） for assessing the severity and death prediction in the pre-hospital traumatic patients. Methods Data of the pre- hospital traumatic patients admitted between January 1, 2010 and December 31, 2010 were collected and assessed onsite by using MEWS. Numeration data was presented in percentage by using chi-square test, and t data was xepressed in mean with standard deviation, and P 〈 0. 05 was considered to be difference with statistical significance. Observation was lasted for 90 days after admission to get final results as observation object and ROC curve was drew and calculated the area under the curve for predicting severity and death of patients. The patients without vital signs and unsuccessful resuscitations were not included in this study. Results There were 1＂475 （87.95%） cases/times with score of 0 -2, and 202 （12.05%） cases/times with score of 3 - 13. In the non-survival group, MEWS were higher than that in the survival group with statistic significance （ P 〈 0.01 ）. When the area under ROC was O. 94, the optimal cutoff point for potentially severe patients was MEWS 〉~3 for predicting the death of severe pre-hospital traumatic patients with sensitivity of 85.7% , specificity of 88. 6% , accuracy of 88.6% and Youden of 0. 743, showing high significance of the application of MEWS to assessing severity of traumatic patients arLd death prediction. Conclusions MEWS used to assess the pre-hospital traumatic patients and predict death with high validity and accurate quantification is a simple, practical and easily operable method with strong application significance.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第6期581-584,共4页
Chinese Journal of Emergency Medicine
基金
广西科技攻关项目（桂科攻0898014）
广西卫生厅资助项目（Z2008360）
柳州市科技局攻关项目（柳科攻2008031418）
作者简介
通信作者：杨家有，Email：yangjy9939@163．com
