ISS评分与CRAMS评分在多发伤患者预后评估中的应用

Application of ISS and CRAMS score for the assessment of the prognosis of patients with multipletrauma

目的比较损伤严重度评分（ISS）和CRAMS评分在急诊科严重多发伤患者预后评估的应用价值。方法对解放军四五四医院急诊科2014年3月至2015年12月接诊的93例严重多发伤患者分别进行ISS和CRAMS评分，追踪其住院期间生存情况。通过两种评分的ROC曲线，评估ISS和CRAMS评分对患者病死率的预测能力。结果93例严重多发伤患者中，ISS（25.59±5.37）分，CRAMS评分（6.75±1.26）分。与生存组相比，死亡组ISS显著高于存活组（t＝7.13，P〈0.01），CRAMS评分显著低于存活组（t＝－6.03，P〈0.01）。在ROC曲线分析中，ISS和CRAMS评分预测多发伤患者病死率的AUCROC分别为0.897和0.891，两者比较差异无统计学意义（Z＝0.718，P〉0.05）。以死亡为预测目标时，ISS的最佳截断点为27分，CRAMS评分为6分。结论CRAMS评分与ISS对急诊科严重多发伤的预后具有同等预测价值，两者各有优势和不足，但CRAMS评分操作简便、易于掌握，其动态变化反映病情及时可靠，有利于院内创伤患者危重症的早期发现与救治。

Objective To compare the clinical value of injury severity score （ISS） and CRAMS （circulation, respiration, abdomen, motor, speech） score in the prognosis of patients with severe multiple trauma in emergency department. Methods A total of 93 severe multiple trauma patients with 69 male and 24 female and age ranged from 21 to78 years with mean age （43.4 ± 14） years admitted in the emergency department from March 2014 to December 2015 were enrolled into this study. All of them were evaluated by using ISS and CRAMS score respectively and their survival during hospitalization was observed. Then, the predictive capabilities of ISS and CRAMS score for the mortality of patients were assessed by using receiver operator characteristic （ROC） curves. Results The mean ISS was （ 25.59 ± 5.37 ） and mean CRAMS score was （6. 75±1.26） in 93 patients with severe multiple trauma. Compared with the survival group （ n = 75）, the ISS in the death group （n = 18） was significantly higher （t =7.13, P 〈0. 01 ） and CRAMS score was significantly lower （ t = - 6. 03, P 〈 0. 01 ）. In the ROC curve analysis, the AUCROC of predicting mortality of multiple trauma patients by ISS score was 0. 897 and CRAMS score was 0. 891, respectively. There was no significant difference in accuracy of predicting mortality between the two scoring systems （ Z = 0. 718, P 〉 0. 05 ）. When the death was chosen as the prediction target, the optimal cut-off point for ISS was 27 and CRAMS score was 6, respectively. Conclusions CRAMS score in comparison with ISS score has the likewise predictive value for the prognosis of severe multiple trauma patients in emergency department. However, the CRAMS score is simple and easy in practice. The changes of CRAMS score demonstrate the severity of trauma timely and reliably, which is in favor of the diagnosis and treatment of hospitalized trauma patients in early stage.