摘要
目的探讨改良早期预警评分(MEWS)对急诊患者病情评估及作为急诊分诊依据的可行性。方法采用便利抽样法,选取2016年4月11日-2017年8月2日江苏省苏州市中西医结合医院急诊科抢救室患者1 643例为研究对象。追踪所有患者的去向,对比不同去向患者的MEWS,通过ROC曲线计算MEWS预测患者死亡的曲线下面积及约登指数;对比入住普通病房及入住ICU患者的MEWS,通过ROC曲线计算MEWS预测住院患者入住ICU的曲线下面积,通过约登指数选择临界值。结果1 643例患者回家475例,留院观察326例,住院768例(其中101例入住ICU,667例入住普通病房),死亡74例。回家、留院观察、住院、死亡4组患者MEWS比较差异有统计学意义(H=236.45,P<0.001)。当MEWS取3.5分时为最佳临界点,其预测患者死亡的ROC曲线下面积为0.910,95%CI(0.87~0.95),约登指数0.72。入住普通病房及入住ICU患者的MEWS比较差异有统计学意义(Z=-9.005,P<0.001)。当MEWS取2.5分时为最佳临界点,其预测住院患者入住ICU的ROC曲线下面积为0.786,95%CI(0.73~0.85),约登指数为0.50。结论MEWS在预测急诊患者死亡及评估患者危重程度有着一定的临床意义,为急诊患者的正确分流及潜在危重患者的正确识别提供客观依据。
Objective To investigate the feasibility of Modified Early Warning Score (MEWS) in evaluating the condition of emergency patients and as a basis for emergency triage. Methods A total of 1 643 patients in the Rescue Room of Emergency Department of Suzhou Integrated Traditional Chinese and Western Medicine Hospital were selected by convenience sampling method from 11th April 2016 to 2nd August 2017. All patients were followed up, and MEWS of patients with different directions were compared. The area under the curve of MEWS and Yoden index were calculated by ROC curve to predict the mortality of patients. Comparing the MEWS of patients in general wards and ICU, the area under the curve of the MEWS was predicted by ROC curve, and the critical value was selected by Yoden index. Results There were 475 cases discharged, 326 cases observed in hospital, 768 hospitalized (101 cases were admitted to ICU, 667 cases were admitted to general wards) and 74 cases died. There was significant difference in MEWS among the four groups (H=236.45, P<0.001) . When the best critical point was 3.5 of MEWS, the area under ROC curve for predicting death was 0.910, 95%CI (0.87-0.95) , and Yoden index was 0.72. There was significant difference in MEWS between patients admitted to general wards and ICU (Z=-9.005, P<0.001) . When picking 2.5 of MEWS as the best critical point, the area under the ROC curve for predicting ICU admission was 0.786, 95%CI (0.73-0.85) , and the Youden index was 0.50. Conclusions The MEWS has clinical significance in predicting the death of emergency patients and assessing the severity of patients. It provides an objective basis for the correct shunt of emergency patients and the correct identification of potentially critically ill patients.
作者
李香娥
屠伟芬
张彪
Li Xiang'e;Tu Weifen;Zhang Biao(Nursing Department,Suzhou Integrated Traditional Chinese and Western Medicine Hospital,Jiangsu Province,Suzhou 215101,China;Emergency Department,Suzhou Integrated Traditional Chinese and Western Medicine Hospital,Jiangsu Province,Suzhou 215101,China;Central ICU,Suzhou Integrated Traditional Chinese and Western Medicine Hospital,Jiangsu Province,Suzhou 215101,China)
出处
《中华现代护理杂志》
2018年第34期4152-4155,共4页
Chinese Journal of Modern Nursing
基金
2016年度苏州市中西医结合医院院级基金(YJ201606).
关键词
急诊室
医院
预后
改良早期预警评分
分诊
Emergency service, hospital
Prognosis
Modified Early Warning Score
Emergency triage
