摘要
目的比较英国国家早期预警评分(National Early Warning Score,NEWS)和改良早期预警评分(Modified Early Warning Score,MEWS)对老年急重症患者病情评估及死亡风险预测的优劣性。方法选取哈尔滨医科大学附属一院急诊内科病房收治的408名老年急重症患者,分别采用NEWS和MEWS对患者进行首次评分,并记录入院时床旁快速检测(point-of-care testing,POCT)。追踪患者的转归情况。评价两种评分对老年急重症住院患者预后判断的相关性,对比两种评分的敏感性及特异性,评价POCT结果在急重症评估中的作用。结果随着NEWS及MEWS分值的增高,患者在各个分值范围的死亡率均有升高。NEWS预测老年急诊住院患者死亡的曲线下面积为0.949,其最佳截断值为6.5分;MEWS预测急诊患者住院的曲线下面积为0.831,其最佳截断值为5.5分。两评分的曲线下面积比较显示NEWS评分较MEWS评分具有较高的敏感性和特异性(P<0.05)。NEWS的约登指数(Youden index)为0.82,MEWS的约登指数(Youden index)为0.51。结论NEWS较MEWS能够更准确地预测老年急重症患者病情,POCT有助于老年急危重症的快速评估。
Objective To compare the advantages and disadvantages of National Early Warning Score(NEWS)with Modified Early Warning Score(MEWS)in the assessment of illness and prediction of mortality risk in elderly patients with acute and severe diseases.Methods Four hundred eight elderly patients with acute and severe diseases in the emergency medical ward of the First Affiliated Hospital of Harbin Medical University were selected,the patients who were admitted to emergency medical ward were scored for the first time with NEWS and MEWS,respectively,and the results of point-of-care testing(POCT)was recorded and the outcome of the patients was tracked.The correlation between the two score systems and the prognosis of elderly inpatients with acute and severe diseases was evaluated,the sensitivity and specificity of the two score systems was compared,the role of POCT results in the assessment of acute and severe diseases was evaluated.Results As the scores of NEWS and MEWS increased,the mortality rate of patients in each score range increased.The AUROC for NEWS of predicting mortality of elderly patients who were hospitalized on wards was 0.949,and the optimal cutoff value was 6.5.The AUROC for MEWS of predicting mortality of elderly patients who were hospitalized on wards was 0.831,and the optimal cutoff value was 5.5.The comparison of AUROCshowed that NEWS had higher sensitivity and specificity than MEWS(P<0.05).The Youden index of NEWS was 0.82,and the Youden index of MEWS was 0.51.Conclusion NEWS is more accurate than MEWS in predicting the condition of elderly patients with acute and severe illness.POCT is helpful for rapid assessment of critical illness in the elderly.
作者
王博
王秀杰
WANG Bo;WANG Xiu-jie(Department of Emergency Medicine,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《哈尔滨医科大学学报》
CAS
2019年第5期536-539,共4页
Journal of Harbin Medical University
基金
卫生部卫生行业科研专项基金(201002011)
