CRAMS评分对地震群体伤员的评估价值研究

Application of CRAMS score for trauma patients in earthquake

目的比较CRAMS评分与国内常用的START检伤分类法对地震伤患者的检伤分类效果.方法回顾性分析四川大学华西医院地震伤员数据库33148例伤员的有效资料,记录其初始临床信息并计算损伤严重度评分(ISS)和CRAMS评分,并通过START检伤分类法将伤员分类.分别以是否重伤、是否死亡、是否入住ICU为标准,采用START和CRAMS评分绘制受试者工作曲线(ROC),计算曲线下面积,并与ISS评分进行相关性分析.结果以是否重伤、是否死亡、是否入住ICU病房为标准,采用START和CRAMS评分的ROC曲线下面积分别为0.513和0.577、0.723和0.800、0.575和0.623,上述均P<0.0001.START和CRAMS评分与ISS评分的Spearman相关系数分别为0.077(P=0.000)和-0.175(P=0.000).结论START和CRAMS评分均有助于地震伤员的检伤分类,但CRAMS评分对伤员是否重伤、是否死亡和是否需要入住ICU的评估更有效.START和CRAMS评分与ISS评分的相关性均较低.

Objective To make a comparison of Simple Treatment and Rapid Transport(START)and CRAMS score(Circulation,Respiration,Abdomen,Motor and Speech)on the triage process for the injured in earthquake.Methods Data of 33148 victims during the earthquake happened in Wenchuan(May 12,h,2008),Yushu(April 14lh,2010),Lushan(April 20lh,2013)and other places were analyzed retrospectively,excluding the patients whose information recorded was incomplete.The initial clinical information was recorded from the earthquake casualty database of West China Hospital of Sichuan University,and the injury severity score(ISS)and CRAMS score were calculated based on the information.Patients were also assigned to“Minor/Green”,“Serious/Yellow”and“Critical/Red”level by START.Subsequently,these two triage methods were evaluated on trauma severity,mortality,and admission to the ICU using receiver operator characteristic curve(ROC curve),and the correlation between ISS and the two triage methods was figured out by liner regression analysis.Results For trauma severity,AUC(area under the receiver-operator curve)of START and CRAMS are 0.513(P<0.0001)and 0.577(P<0.0001).For mortality,AUC of the two methods are 0.723(P<0.0001)and 0.800(P<0.0001).For ICU admission standard,AUC of the two methods are 0.575(P<0.0001)and 0.623(P<0.0001).Moreover,liner regression analysis indicates that START showed a positive correlation with ISS score(r=0.077,P=0.000),while CRAMS score shows a negative correlation(r=-0.175,P=0.000).Conclusion The two triage methods are considered being useful in assessing the injured in Wenchuan earthquake and CRAMS scoring method performs better than START in the assessment on patients,trauma severity,mortality and also the ICU admission,but the correlation between the two and ISS score is low.