APACHEⅡ与TRISS评分系统对急诊重症创伤患者预后预测的比较

A comparison of APPACHE Ⅱ and TRISS in emergency department for outcome assessment in critically injured patients

目的比较急性生理和慢性健康状况评价系统(APACHE)Ⅱ与创伤严重程度评分(TRISS)对急诊重症创伤患者死亡率的预测能力。方法将2010年4月至2011年5月在本院急诊抢救室治疗的重症创伤患者纳入本研究。统计患者的一般资料、受伤机制、手术、APACHEⅡ和TRISS评分等,并预测死亡率,预测结果与实际死亡率比较,通过受试者操作工作特征曲线下面积(ROC曲线)和诊断结果判断两种评分模型对死亡率的预测能力。结果 282例患者中,33例死亡(11.7%),249例存活(88.3%)。死亡患者和存活患者两组比较,APACHEⅡ、RTS、ISS和年龄均有显著差异。通过ROC曲线下面积分析,急诊APACHEⅡ和TRISS的ROC曲线面积为0.90±0.03和0.76±0.05。APACHEII的预测能力更好,P<0.05。以0.5为判断死亡标准,经Kappa检验,APACHEⅡ、TRISS与实际死亡率的一致性为0.64(P<0.05)和0.43(P<0.05)。结论急诊APACHEⅡ和TRISS都能准确预测急诊重症创伤患者的死亡率,APAHCEⅡ的预测价值更高。

Objective To assess the ability of the revised acute physiologic and chronic health evaluation （APACHE） Ⅱ system and traumainjury severity scoring （TRISS） system in emergency department （ED） resuscitation room for prediction of mortality in critically injured patients. Methods Consecutive critically injured patients admitted to the ED from April 2010 to May 2011 was enrolled. Demographic data,mechanism of in- jury,and surgical status were collected. Revised trauma scores and injury severity scores were calculated from emergency room and operative data to calcute the TRISS scores. The worst data within 24 hours of admission were collected and analyzed for APACHE Ⅱ scores. The ability to predict mortality for APACHE Ⅱ and TRISS was compared using receiver operating characteristic （ROC） and Kappa analysis. Results 282 patients were included in the study, of whom 33 （11.7%） died and 249 （88.3%） survived. There were significant differences between survivors and nonsurvivors in age, Glasgow coma scale（GCS）, revised trauma score, injury severity score and APACHE Ⅱ score. The area under the ROC curve of APACHE Ⅱ and TRISS were 0.90±0.03 and 0.76±0.05. With a decision criterion of 0.5, Kappa for diagnostic agreement for APACHE Ⅱ was 0.64 （P〈0.05）, while for TRISS was 0.43 （P〈0.05）. Conclusion Both APACHE Ⅱ and TRISS scores were shown to accurately predict group mortality in ED critically trauma patients. APACHE Ⅱ is superior to TRISS for prognosis prediction of patients with critically trauma.