CRAMS评分评估急性创伤患者预后的价值

Value of CRAMS score for assessing prognosis in patients with acute trauma

目的 研究CRAMS评分系统评估急性创伤患者预后的实用性及可行性. 方法 回顾性分析急性创伤患者1 802例,分别行CRAMS评分和ISS,绘制受试者工作特征曲线（receiver operation characteristic curve,ROC）,计算曲线下面积（area under the curve,AUC）.以ISS为参照,比较CRAMS评分预测急性创伤患者预后的价值. 结果 CRAMS评分AUC为0.885 （95％ CI0.870 ～0.900）,ISS的AUC为0.792（95％ CI0.773 ～0.811）（Z=4.280,P＜0.01）.判断“潜在危重症”的最佳截断点分别为CRAMS≤7分、ISS≥24分;CRAMS评分对危重症患者死亡预测的灵敏度优于ISS（x^2=16.910,P＜0.01）,特异度低于ISS（x^2=5.260,P＜0.05）,准确度低于ISS（x2=0.693,P＞0.05）. 结论 CRAMS评分评估急性创伤患者预后的准确性优于ISS.CRAMS评分操作简便、易于掌握、反映病情及时可靠,有利于院内创伤患者危重症的早期发现与救治.

Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve （ROC） was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve （RUC） was 0.885 for CRAMS （95 % CI 0.870-0.900） and was 0.792 for ISS （95% CI 0.773-0.811）,with statistical difference of the two scoring systems （Z=4.280,P 〈0.01）.To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity （X^2 =16.910,P 〈 0.01）,but lower specificity （x2 =5.260,P 〈 0.05） and accuracy （X^2 =0.693,P 〉 0.05） for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.