MEWS与APACHEⅡ评分在急诊潜在危重病患者病情评价和预后预测中的对比研究

COMPARISON OF MODIFIED EARLY WARNING SCORE(MEWS) AND APACHE Ⅱ SCORE IN EVALUATION SEVERITY AND PREDICTION OUTCOME OF EMERGENCY POTENTIAL SEVERITY DISEASE

目的比较APACHEⅡ和MEWS评分在急诊潜在危重病病情评价和预后预测中的适用性和可行性。方法分别对急诊科留观察和抢救室的501例患者进行APACHEⅡ和MEWS评分,追踪所有患者的去向和预后。分别比较APACHEⅡ和MEWS评分不同分数段患者收住ICU、HDU、门诊治疗的构成比;死亡、1月以内出院、门诊治疗后痊愈的构成比;比较A-PACHEⅡ和MEWS评分对患者病情评价和预测预后分辨度的ROC曲线差异。结果MEWS评分5分以上,危重患者的构成比明显增加,与5分以下相比差异显著(P<0.05)。MEWS评分5分以上对危重患者(需要收住ICU)鉴别的灵敏度为100%,特异度为81.5%;对需要收专科病房治疗患者鉴别的灵敏度为84.3%,特异度为88.3%。APACHEⅡ评分15分以上,危重患者的构成比明显增加,与15分以下相比,差异显著(P<0.05)。APACHEⅡ评分15分以上对危重患者(需要收住ICU)鉴别的灵敏度为89.2%,特异度为96.3%;APACHEⅡ评分10分以上对需要收专科病房治疗患者鉴别的灵敏度为94.3%,特异度为82.3%。就患者是否收住ICU或患者病死危险性的预测和评估的鉴别能力而言,MEWS和APACHEⅡ评分两者相当,其ROC曲线下面积均在0.90以上,具有较高的分辨能力,但两者间无显著差异(P>0.05);而在是否收住专科病房的鉴别能力上,APACHEⅡ评分显著高于MEWS(P<0.05)。结论APACHEⅡ评分和MEWS评分均可用于判断急诊患者的病情严重程度,有一定的识别“急诊潜在危重病”的能力。而MEWS评分因快速、简捷、费用低廉和便于操作,更适用于急诊科。

Objective To compare the applicability and practicability of MEWS and A- PACHE Ⅱ in evaluating severity and predicting outcome of emergency potential severity disease. Methods Dada of all 501patients in emergency observation ward and rescue room were recorded and scored with MEWS and APACHE Ⅱ score respectively. Main outcome measures were cardiac arrest and CPCR, intensive care unit （ICU） admission, high dependency unit （HDU） admission, outpatient ; death , hospital discharge in 3 0 days . Ratio of patients in deferent score segments for these indexes were compared respectively as well as area under of ROC curve of MEWS and APACHE Ⅱ score in some of these indexes . Results A ScoreMax of 5 or more was associated with an increase risk of death, ICU admission and HDU admission for MEWS. Ratio of severity patients in score of 5 or more was significantly higher than that of score of less to 5 （ P 〈 0.05）. The sensitivity was 100 % and specificity was 81.5 % when 5 of MEWS were used to discriminate the ICU admission of patients; the sensitivity was 84.3% and specificity was 88.3% for HDU admission. A Score Max of 15 or more was associated with an increase risk of death, ICU admission and HDU admission for APACHE Ⅱ score. Ratio of severity patients in score of 15 or more was significantly higher than that of score of less than 15 （ P 〈 0.05 ）. The sensitivity was 89.2% and specificity was 96.3% when 15 of APACHE H score were used to discriminate the ICU admission of patients; the sensitivity was 94.3 % and specificity was 82.3 % for HDU admission at 10 of APACHE Ⅱ score. In discriminating the ICU admission and death risk of patients, MEWS had considerable power compared with APACHE H score （ P 〉 0.05 ）. All of MEWS and APACHE Ⅱ had good discriminating power for ICU admission and death risk of patients. APACHE Ⅱ had better power in discriminating HDU admission compared with MEWS （ P 〈0.05）. Conclusion All of MEWS and APACHE H can be used to evaluate severity of emergency patients and discriminate the emergency potential severity patients. MEWS may be the first one because of speediness, simplicity, less of spending and handiness compared with A- PACHE Ⅱ.