摘要
目的探讨改良早期预警评分(MEWS)应用于急诊入院的脑外伤患者预后预测的可行性。方法依据事先设定的入组及排除标准,选取2007年1月～2008年3月经我院急诊收入院的连续脑外伤患者共计94例。入院即刻作为观察起点,采集相关数据或化验标本。其后对每一位患者分别进行APACHEⅡ评分及MEWS评分;3个月后为观察终点;预后作为观察指标。资料收集完后进行统计分析。结果以死亡作为预测指标时,APACHEⅡ评分界值是21分,敏感度100%,特异度94.81%;ROC曲线下面积Az=0.9809;U=39.0337;P=0.0000。MEWS评分界值是5分,特异度100%,敏感度88.31%,ROC曲线下面积Az=0.9756;U=35.2844;P=0.0000。均有较强的预测价值。在存活组中,以致残为预测目标时,APACHEⅡ评分界值是16分,Az=0.8653,U=4.2115,P=0.0000,敏感度85.10%,特异度76.00%。MEWS评分界值是3分,Az=0.8255,U=3.8424,P=0.0001。敏感度85.71%,特异度75.71%;均有中等强度预测价值。结论APACHEⅡ评分及MEWS评分对脑外伤患者愈后均具有同等预测价值,但MEWS评分结构简单,获取数据方便,省时、节省费用,故可在急诊入院脑外伤患者预后预测中推广应用。
Objective To study the feasibility of the application of MEWS grade to the prognosis forecast of brain-in- jured at emergency room. Methods According to prefixed choosing and excluding standards, we chose 94 cases of brain-injured that hospitalized from Jan. 2007 to Mar. 2008 in our hospital. We observed them, gathered the data and the samples for test as soon as they hospitalized;then we gave grade to every patient according to the APACHE Ⅱ and MEWS separately;we finished the ob- servation after three months and took the prognosis as the observing index;lastly we made the statistical analysis after the data-col- lection. Results When choose the death as the forecast index, the cut-off of APACHE Ⅱ grade is 21, Sen = 100%, spe = 94. 81% ;and area of ROC＇s curve：Az=0. 9809;U=39. 0337;P=0. 0000. The cut-off of MEWS grade is 5, Sen= 100% ,Spe= 88.31% ; and area of ROC＇s curve： Az = 0. 9756 ; U = 35. 2844 ; P = 0. 0000. They all show strong intensity of forecasting value. However,when choose the mutilation as the forecast index,the cut-off of APACHE Ⅱ grade is 16,and area of ROC＇s curve：Az= 0. 8653 ,U=4. 2115 ,P=0. 0000, Sen= 85.10%, Spe=76.00%. The cut-off of MEWS grade is 3. Az=0. 8255, U=3. 8424,P= 0. 0001. Sen = 85.71%, Spe = 75.71%. They all show midium intensity of forecasting value. Conclusion It is proved that the A- PACHE Ⅱ and MEWS show forecast value on an equal basis,but MEWS is proved to have more simple grading structure and own the advantage of time-saving as well as economical. Therefore, the MEWS is more suitable to popularize in the prognosis forecast of brain-injured at emergency room.
出处
《四川医学》
CAS
2009年第8期1261-1263,共3页
Sichuan Medical Journal
关键词
改良早期预警评分
脑外伤
预测
预后
死亡
modified early warning score grade （MEWS）
brain-injured
predicationt
prognosis
death
