社区成年危重发热患者的早期预警技术研究

The study on early warning technique for critically Ill adult patients with acute fever in community

目的:建立社区成年发热患者病情严重度评分标准(adult fever state score,AFSS),形成社区成年危重发热患者的早期预警技术。方法:回顾性收集357例急性发热患者临床资料,通过Logistic回归筛选发热患者病情严重度的独立危险因素,并赋予各指标反映病情严重度的权重分值,据此建立AFSS。应用ROC曲线评价其诊断准确性,Kappa检验评估诊断可靠性,病情轻重的临界值为cutoff值。AFSS与住院率、住院病死率的相关性分析采用χ2检验,与住院时间相关性采用Kruskal-Wallis检验。结果:筛选出年龄、发热病程、既往体健与否、体温、呼吸频率、心率、平均动脉压、白细胞计数为反映发热患者病情轻重的独立危险因素,每个指标根据其权重分别赋予0～3分,建立AFSS。AFSS的ROC曲线下面积为0.964,cutoff值为7分,Kappa值为0.801。随着AFSS评分的增加,患者病情加重,住院率、住院病死率及住院时间随之增加(P<0.05),AFSS对预后的预测效能明显高于早期预警评分。结论:AFSS具有很高的诊断准确性和可靠性,利于急诊医师早期识别社区发热危重患者。

Objective：To identify risk factors for critically ill patients with acute fever in community and formulate an early warning technique of adult fever state score（AFSS） for out-patient clinic doctors in determining treatment and referral. Method：Three hundred and fifty seven adult patients with acute fever were divided into two groups： 180 patients with a severe state and 177 patients with a mild state. Logistic regression was used to determine risk factors for the severe state. Risk factors were weighted and an AFSS was formulated. A receiver operating characteristic（ROC） analysis of weighted cumulative scores was performed to evaluate the diagnostic accuracy of AFSS,and the kappa test was used to confirm diagnostic reliability. Scores of patients greater than cutoff value predicted severe state. A χ2 test for trend was applied to determine the relevance between AFSS and admission rate and in-hospital mortality. A Kruskal-Wallis test was used to examine the relationship between AFSS and length of stay. Result：Risk factors for state were old age,long fever course,past medical history,abnormal temperature,abnormal respiratory rate,abnormal heart rate,abnormal（MAP） and abnormal peripheral white blood cell count. The area under the ROC curve（AUC） of AFSS was 0.964 and the cutoff value was 7 points;the Kappa value was 0.801. With an increase in score,there was an increase in admission rate,mortality rate and length of stay. The forecast performance of AFSS was superior to the modified early warning score（MEWS） . Conclusion：The AFSS has high diagnostic accuracy and reliability to early identify critically ill patients with acute fever in community for out-patient clinic doctors.