CRAMS评分对急诊创伤患者病情及预后评估的应用价值

Application Value of CRAMS Score in Evaluation of Condition and Prognosis in Patients with Emergency Trauma

目的:总结CRAMS评分评估急诊创伤患者病情及预后的临床价值。方法:以2020年1月至2020年12月广东省汕尾逸挥基金医院急诊收治的153例创伤患者为研究对象,急诊入院时均分别以CRAMS量表和ISS量表对创伤严重程度进行评估,比较急诊救治后生存患者与死亡患者的CRAMS评分与ISS评分,并绘制受试者工作特征曲线,按照约登指数最大法选取最佳截断点,以CRAMS 7分为临界值将患者分为C-轻症组(CRAMS>7分,125例)和C-重症组(CRAMS≤7分,28例),以ISS 24分为临界值将患者分为I-轻症组(ISS<24分,134例)和I-重症组(ISS≥24分,19例),比较各组死亡率。结果:139例患者生存,救治成功率90.85%,14例死亡,死亡率9.15%。死亡患者CRAMS评分明显低于生存患者[(5.97±1.84)vs(9.14±1.26),P<0.05],ISS评分明显高于生存患者[(21.77±6.51)vs(13.48±5.12),P<0.05]。CRAMS量表评估危重创伤灵敏度明显高于ISS量表(83.9%vs 63.6%,P<0.05)。C-重症组与I-重症组患者死亡率分别为32.1%和31.6%,分别高于C-轻症组与I-轻症组,差异有统计学意义(P<0.05)。结论:CRAMS评分法评估急诊创伤患者病情及预后的敏感度优于ISS。

Objective:To summarize the application value of CRAMS score in the evaluation of the condition and prognosis in patients with emergency trauma.Methods:153 patients with trauma admitted to the emergency department of our hospital from Jan 2020 to Dec 2020 were selected as the research object,and were evaluated for the severity of trauma using the CRAMS scale and the ISS scale when they were admitted to the emergency department.The CRAMS scores and ISS scores of surviving cases and dead cases after emergency treatment were compared,and the receiver operating characteristic curve were draw,and select the best according to the Yoden index maximum method.According to the best cut-off point,the patients were divided into C-mild group(CRAMS>7 points,125 cases)and C-severe group(CRAMS≤7 points,28 cases)according to the critical value of CRAMS 7,I-mild group(ISS<24 points,134 cases)and I-severe group(ISS≥24 points,19 cases)according to the critical value of ISS 24,The mortality of each group were compared.Results:After emergency treatment,139 cases survived,the success rate was 90.85%,14 cases died,and the mortality rate was 9.15%.The CRAMS score in the dead cases was significantly lower than that in the surviving cases[(5.97±1.84)vs(9.14±1.26),P<0.05],and the ISS score(21.77±6.51)was significantly higher than that in the surviving cases[(21.77±6.51)vs(13.48±5.12),P<0.05].The sensitivity of CRAMS scale assessment of critical trauma was significantly higher than that of ISS scale(83.9%vs 63.6%,P<0.05).The mortality rates of patients in the C-severe and I-severe groups were 32.1%and 31.6%,respectively,which were higher than those of the C-mild and I-mild groups,and the difference was statistically significant(P<0.05).Conclusion:The CRAMS scoring method is more sensitive than ISS in evaluating the condition and prognosis of patients with emergency trauma.