外伤MEWS评分和传统MEWS评分对成人急诊多发伤患者预后评估的临床研究

Cfinical study between IMEWS score and MEWS score for evaluation the prognosis of multiple injuries in emergency department

目的比较传统MEWS评分（MEWS）和外伤MEWS（IMEWS）评分，对成人急诊多发伤病情评价和对预后预测的适用性和可行性。方法对我院急诊科2010—03～2012—03收治的262例急诊多发伤患者，分别进行MEWS、IMEWS评分和ISS评分，追踪其7d内的生存情况，分析不同评分对患者病死率的预估能力。结果在区分患者疾病严重程度和死亡率方面，MEWS评分和ISS评分二者相当，它们的ROC曲线下面积分别为0．804和0．798，具有中等判断能力。IMEWS评分明显优于MEWS评分，ROC曲线下面积Az=0．962，ROC曲线分界点5．5分所对应的正确诊断指数（Youden指数）最大为0．8314，其敏感性0．929，特异性0．895，是患者死亡预测的独立危险因素。结论IMEWS评分可用于判断急诊多发伤患者的病情严重程度，有一定识别“急诊潜在危重症”的能力。

Objective To compare the applicability and practice ability of MEWS and IMEWS in evaluating severity and predicting outcome of multiple injuries in emergency department. Methods The patients who were hospitalized to emergency department with trauma were enrolled in study from Mar. 2010 to Mar. 2012. All of the 262 patientswere evaluated with MEWS,IMEWS and ISS instantly when they were sent to emergency department. Prognosis within 7 days were followed - up and their relationship, correlation with three kinds of scores were statistical analyzed after dividing into groups retrospectively. Results In discriminating severity and death risk of patients, MEWS had considerable power, the MEWS with AUROCC 0.804 and the ISS with AUROCC O. 798. All of MEWS and ISS had moderate discriminating power for death risk of patients. IMEWS had better power in discriminating severity and death risk compared with MEWS（P 〈0.01 ）. The IMEWS with AUROCC 0. 962 and the best cutoff score 5.5 had good discrimination on mortality. The Youden index was 0.8314, the sensitivity was O. 929 and specificity was 0. 895 when 5.5 of IMEWS were used to discriminate. IMEWS was the independent risk factor of patients died prediction. Conclusion IMEWS can be applied to evaluate quickly the emergency multiple injuries, especially in distinguishing emergency potential critical disease.