NEWS评分与MEWS评分在成人潜在危重症患者病情识别中的对比研究

Comparative Study of NEWS Score and MEWS Score in the Condition Identification of Adult Patients with Potential Critical Illness

目的比较国家早期预警评分(NEWS)和改良早期预警评分(MEWS)在成人患者潜在危重病识别及死亡风险识别中的优劣性。方法选取在我院就诊住院内科、外科病区的5007例成人潜在危重症患者,分别采用NEWS和MEWS对患者进行首次评分,并记录患者的转归情况;统计两种评分低危、中危、高危级别组死亡与存活患者的平均分值,绘制患者死亡风险的曲线下面积(ROCC),对比两种评分的敏感性及特异性。结果NEWS与MEWS评分均能对成人潜在危重症患者病情变化进行预警;评分>4分的中高危组,随着NEWS及MEWS分值的增高,患者在各个分值范围的死亡率均有升高,NEWS与MEWS评分的高危级别组患者死亡率比较有统计学意义(P<0.05);NEWS预测成人潜在危重症患者死亡的曲线下面积为0.780,其最佳截断值为6.5分;MEWS预测成人潜在危重症患者死亡的曲线下面积为0.762,其最佳截断值为5分;两评分的曲线下面积比较显示NEWS评分较MEWS评分具有较高的敏感性和特异性(P<0.05);NEWS、MEWS的约登指数(Youden index)分别为0.546、0.437。结论NEWS较MEWS更能准确地预测成人潜在危重症患者病情变化及死亡风险。

Objective To compare the advantages and disadvantages of national early warning score(NEWS)and modified early warning score(MEWS)in the identification of potential critical illness and death risk of adult patients.Methods 5007 potentially critical adult patients in medical and surgical wards of our hospital were selected.They were scored for the first time with NEWS and MEWS,respectively,and the outcome of the patients was recorded;the average scores of death and survival patients in low-risk,moderate-risk and high-risk groups of NEWS and MEWS were counted;then the area under the curve(ROCC)of patients'death risk was drawn and the sensitivity and specificity of the two scores were compared.Results Both NEWS and MEWS scores can be used to warning the condition changes of adult potentially critical patients;With the increase of NEWS and MEWS scores,the mortality of patients in each score range increased,and there was a statistically difference in mortality of patients in high risk group between NEWS and MEWS scores(P<0.05);NEWS predicted the area under the curve of death of adult potentially critical patients was 0.780,its best cut-off value was 6.5 points;MEWS predicted the area under the curve of death of adult potentially critical patients was 0.762,its best cut-off value was 5 points;The area under the curve of the two scores showed that NEWS score had higher sensitivity and specificity than MEWS score(P<0.05);The Youden index of NEWS and MEWS was 0.546 and 0.437 respectively.Conclusion NEWS can predict the condition of adult potentially critical patients and death risk more accurately than MEWS.