主动脉夹层风险评分表在早期分诊中应用的效果评价

Preliminary assessment on Risk Score Scale for aortic dissection in early triage stage

目的初步评价主动脉夹层风险评分表在早期分诊中应用的有效性。方法分诊护士根据预先制订的分诊用主动脉夹层风险评分表，对2011年至2013年就诊的主诉为急性胸背痛251例患者进行分诊。经过影像学确诊患者95例（列为确诊组），其中评分≥5分的87例，≥6分的80例。排除主动脉夹层患者156例作为对照组。比较2组患者的一般情况、主动脉夹层危险因素分布、危险因素评分结果、评分方法的灵敏度与特异度。并对评分结果≥5分及≥6分的分诊误诊率、漏诊率、特异度、灵敏度、OR值进行了比较。结果2组患者在撕裂样剧烈胸背痛、脉搏短绌或双上肢收缩压差≥20mmHg（1mmHg=0．133kPa）或双下肢收缩压差≥10mmHg这些危险因素的分布上比较，差异有统计学意义χ^2值分别为62．6，94．2和20．2。评分≥5分时分诊的灵敏度与特异度最高。评分≥5分时分诊为急性主动脉夹层具有较高的灵敏度，较低的漏诊率及很高的OR值。结论评分≥5分可以作为急性主动脉夹层早期分诊的可靠依据。

Objective We aimed to assess effectiveness of Risk Score Scale （RSS） for aortic Dissection （AD） in early triage stage. Methods A total of 251 patients with acute chest or back pain complaints were allocated by triage nurses according to the pre-established RSS from 2011 to 2013. 87 cases were assessed to have 5 points or more, and 80 cases were assessed to have 6 points or more from 95 patients diagnosed as aortic dissection （the diagnosed group） by CT angiography and magnetic resonance imaging while excluded 156 cases of control after discharge （control group）. The general conditions, distribution of aortic dissection risk factors, aortic dissection risk score, sensitivity and specificity of RSS between two groups were compared. The misdiagnosis rate, missed diagnosis rate, RSS triage sensitivity and specificity and OR value were compared between RSS≥5 points and RSS≥6 points. Results There was significant differences in abrupt onset of severe pain intensity, ripping or tearing pain, pulse deficit or systolic blood pressure differential between extremities [upper extremity ≥ 20 mmHg （1 mmHg=0.133 kPa） or lower extremity ≥ 10 mmHg], χ^2 value was 62.6, 94.2 and 20.2. RSS ≥ 5 points had high sensitivity and specificity, lower missed diagnosis rate and high OR value for triage application. Conclusion RSS≥5 points could serve as a reliable evidence for early triage of aortic dissection.