校正改良早期预警评分在院前急救中的应用分析

Analysis on the application of modified early warning score in prehospital emergency

目的 探讨校正改良早期预警评分（modified early warning score,MEWS）系统在院前急救患者病情评估和死亡预测方面的价值及可行性.方法 以收治的297例院前急救患者作为研究对象,急救现场采集相关数据,进行MEWS评分,以收入院后30 d为观察终点,评分结果作为观察指标.结果 生存组289例,病死组8例,病死组MEWS评分较存活组高,两组MEWS评分比较有统计学意义（Z=6.28,P＜0.01）.MEWS评分ROC曲线下面积（AUR）为0.992,判定院前急救患者危重程度最佳截断点为≥3分.该评分对院前急救患者死亡危险预测的敏感度为100％,特异度为93.10％,准确度为93.27％（277/297）,假阳性率为6.90％,约登指数为0.93.以3分为界值,0～2分患者268例,占90.24％;3～17分患者29例,占9.76％;两组病死率比较有统计学意义（χ2=85.77,P＜0.001）.结论 MEWS评分对院前急救患者病情评估和死亡的预测具有较好价值,加之该评分方法简单、可操作性强,因而具有较强的应用价值.

Objective To investigate the value and feasibility of modified early warning score （MEWS） system in patients＇ situation assessment and death prediction in the prehospital emergency. Methods 297 cases of patients＇ relevant data were collected in emergency center of Kunshan city as the research object and MEWS ratings were conducted, with 30 days after adnfitting as the end of the observation. The scores were used as observation indexes. Results The results showed that there were 289 cases of patients in the survival group and 8 cases in the death group. The MEWS score of the death group were significantly higher than that of the survival group. Area under ROC curves scored by MEWS was 0. 992, so the cnt-off point for judging critical degrees of prehospital patients was 3. The sensitivity of MEWS for prediction of death risk of prehospital patients was 100% , specificity was 93.1% , accuracy was 93. 27% （277/297） , false positive rate was 6.9% , Youden index was 0.93. Score 3 was used as the boundry value, 268 patients scored 0-2, accounting for 89.90% ; 30 patients with 3-17, accounting for 10.10%. The fatality rate of the two group was statistically signifi- cant （χ2 = 85.77,P 〈 0. 001 ）. Conclusions MEWS score is helpful in patients＇ situation assessment and death prediction in the pre- hospital emergency. And also it is simple, manipulable, so it has strong application value.