摘要
目的探讨应用智能计算(IC)法对住院患者进行风险评估的准确性,旨在构建更具优势的住院风险评估系统。方法以天津市第五中心医院医院信息系统(HIS)为平台研发"搜索引擎"程序,自动抓取患者信息,应用IC法自动生成营养风险筛查2002量表(NRS 2002)评分、评估静脉血栓栓塞症(VTE)风险的Caprini评分和Padua评分、房颤脑卒中危险分层管理评分(CHA_(2)DS_(2)-VASc评分)以及房颤患者抗凝出血风险评分(HAS-BLED评分)。采用随机对照研究方法,按照各项评分适用条件,分别随机选取100例次应用IC法进行评分,定义为IC组;用与上述例次对应的同一患者相同时间的资料进行人工评分,定义为传统计算(TC)组。绘制Bland-Altman散点图分析两种方法计算各风险评分的一致性,比较两组评分消耗时间的差异。结果两组评分Bland-Altman散点图显示,NRS 2002评分、Caprini评分、Padua评分、CHA_(2)DS_(2)-VASc评分和HAS-BLED评分的95%一致性界限(95%LoA)分别为-0.46~0.41、-0.49~0.52、-0.50~0.41、-0.67~0.60、-0.44~0.43分,均P>0.05。在NRS 2002评分、Caprini评分、Padua评分、CHA_(2)DS_(2)-VASc评分和HAS-BLED评分中,分别有95%、96%、97%、97%、95%的点落在各自95%LoA内,且所有95%LoA内点均在临床可信区间内(-0.5~0.5分)。IC组计算NRS 2002评分、Caprini评分、Padua评分、CHA_(2)DS_(2)-VASc评分和HAS-BLED评分所消耗时间均明显短于TC组〔分别为0.72(0.71,0.73)s比361.02(322.41,361.02)s,0.72(0.72,0.73)s比196.68(179.99,291.20)s,0.72(0.72,0.73)s比105.75(92.32,114.70)s,0.72(0.71,0.72)s比72.66(56.24,84.20)s,0.72(0.71,0.72)s比51.30(38.88,57.15)s,均P<0.001〕。结论在上述5项住院风险评分中,IC法与TC法的评分结果存在良好的一致性,而IC法计算速度更快,值得临床信任与推广。
Objective To explore the accuracy of intelligent calculation(IC)method for risk assessment of hospitalization for patients,aiming to build a more advantageous risk assessment system.Methods The"Search Engine"program was developed based on hospital information system(HIS)of the Fifth Center Hospital in Tianjin,which automatically captured patient information and generated nutritional risk screening 2002(NRS 2002)score,Caprini thrombosis risk assessment model and Padua thrombosis risk assessment model for venous thromboembolism(VTE),the CHA_(2)DS_(2)-VASc for predicting stroke risk stratification in atrial fibrillation and the HAS-BLED for predicting bleeding risk in anticoagulated patients with atrial fibrillation.A randomized controlled trial was conducted.According to the applicable conditions of each risk assessment,100 risk scores from"Search Engine"program belonged to each risk assessment were randomly selected,defined as the IC group.Manual scoring with the data of the same case at the same time,defined as the traditional calculation(TC)group,compared the consistency of the scores and the difference in time-consuming between the two groups.Results The Bland-Altman plots showed that the 95%limits of agreement(95%LoA)of NRS 2002 score,Caprini score,Padua score,CHA_(2)DS_(2)-VASc score and HAS-BLED score was-0.46 to 0.41,-0.49 to 0.52,-0.50 to 0.41,-0.67 to 0.60,-0.44 to 0.43,respectively,all P>0.05.In this study,the Bland-Altman plot showed that 95%,96%,97%,97%,95%plots fell within the 95%LoA in NRS 2002 score,Caprini score,Padua score,wwCHA_(2)DS_(2)-VASc score and HAS-BLED score by the two methods,respectively.The all plots of 95%LoA were within the clinically acceptable range(-0.5 to 0.5 scores).The time-consuming of NRS 2002 score,Caprini score,Padua score,CHA_(2)DS_(2)-VASc score and HAS-BLED score in IC group were significantly shorter than those in TC group[0.72(0.71,0.73)seconds vs.361.02(322.41,361.02)seconds,0.72(0.72,0.73)seconds vs.196.68(179.99,291.20)seconds,0.72(0.72,0.73)seconds vs.105.75(92.32,114.70)seconds,0.72(0.71,0.72)seconds vs.72.66(56.24,84.20)seconds,0.72(0.71,0.72)seconds vs.51.30(38.88,57.15)seconds,respectively,all P<0.001].Conclusion For the above five risk assessments,the TC method and IC method has good consistency in scores,and the IC method is faster,which has good application prospect for clinical application.
作者
杨万杰
侯晓明
孟祥飞
康波
刘晓智
张海燕
王骏飞
宋迎
张森乐
程秀玲
Yang Wanjie;Hou Xiaoming;Meng Xiangfei;Kang Bo;Liu Xiaozhi;Zhang Haiyan;Wang Junfei;Song Ying;Zhang Senle;Cheng Xiuling(Department of Critical Care Medicine,the Fifth Center Hospital in Tianjin,Tianjin 300450,China;National Super Computer Center in Tianjin,Tianjin 300457,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第5期533-537,共5页
Chinese Critical Care Medicine
基金
天津市卫生健康科技项目(ZC20034)。
关键词
住院患者
风险评分
搜索引擎程序
智能计算法
评分耗时
Hospitalized patient
Risk assesment
Search engine program
Intelligent calculation method
Time-consuming
作者简介
通信作者:杨万杰,Email:yangwanjie0709@126.com。
