不同评分对急诊危重患者病情及预后评估应用

Study of Different Score Systems on Evaluating Severity and Predicting Outcomes in Severe Patients of Emergency Departments

目的探讨简单临床评分(simple clinical score,SCS)、快速急诊内科评分(rapid emergency medical score,REMS)、改良的早期预警评分(modified early warning score,MEWS)和急性生理和慢性健康状况评分(APACHEⅡ评分)在评估急诊危重患者病情及预后的应用。方法对急诊科570例患者进行SCS评分、REMS评分、MEWS评分和APACHEⅡ评分,追踪患者去向和预后,并根据收住ICU率及病死率,比较不同评分与急诊危重患者病情及预后的相关性,同时通过受试者工作特征曲线(receiver operator characteristic curve,ROC)下面积大小,比较不同评分系统对危重患者预后的评估准确度。结果 SCS评分、REMS评分、MEWS评分和APACHEⅡ评分分值越高,死亡危险率越高,各分组间收住ICU比例及病死率比较,差异均有统计学意义(P<0.001);SCS评分、REMS评分、MEWS评分和APACHEⅡ评分下,收住ICU比例的ROC曲线下面积分别为0.933、0.940、0.964和0.945。死亡率的ROC曲线下面积分别为0.804、0.792、0.773和0.837。SCS评分、REMS评分、MEWS评分以及APACHEⅡ评分之间的收住ICU比例的比较ROC曲线下面积差异无统计学意义(P>0.05)。SCS评分、REMS评分、MEWS评分分别与APACHEⅡ评分比较死亡率的ROC曲线下面积差异均有统计学意义(P<0.01),SCS评分、REMS评分和MEWS评分之间的死亡率比较ROC曲线下面积差异均无统计学意义(P>0.05)。结论不同评分系统均能预测患者的预后,其预测准确度以APACHEⅡ更高;从临床可操作程度考虑,SCS评分、REMS评分、MEWS评分更适用于急诊患者的早期预后评估。

Objective To discussed the simple clinical score（SCS） ,rapid emergency medical score（REMS） ,modified early warning score（MEWS） and APACHE Ⅱ score in evaluating severity and predicting prognosis of severe patients in emergency department. Methods Data of 570 patients were collected at and after admission. SCS score, REMS score , MEWS score and APACHE Ⅱ score were calculated. Intensive care unit （ ICU ） admission and the mortality of patients with different score system was analyzed in order to evaluate the sensitivity and specificity of the three score system confirmed by area under the ROC curve. Results With scores increased,mortality rate was increased as a result of severity of illness. There were differences in mortality rate among the three score system （P 〈 0.01 ）. The area of ICU admission under ROC curve of SCS, REMS, MEWS and APACHE Ⅱ scores were 0. 933,0. 940,0. 964 and 0. 945 respectively. The areas of mortality rate under ROC curves of SCS,REMS,MEWS and APACHE Ⅱ scores were 0. 804,0. 792,0. 773 and 0. 837 respectively. The difference in area under the ROC curves between SCS,REMS,MEWS and APACHE Ⅱ score was significant（P 〈 0.01 ） , and difference in area under the ROC curve between SCS, REMS and MEWS score was not significant （ P 〉 0.05 ）, while there was no significant difference in area of ICU admission under the ROC curves between SCS, REMS, MEWS and APACHE Ⅱ score（ P 〉 0.05 ）. Conclusion The four different score systems are useful in evaluating severity and predicting outcomes of severe patients, APACHE Ⅱ has higher prediction accuracy. From clinical operational considerations, SCS, REMS and MEWS score are more suitable for the early prognosis and assessment for the patients in emergency.