三种早期预警评分系统对多发伤患者病情评估效果比较

Comparison of evaluation effects of three early warning scoring systems on patients with multiple injuries

目的探讨三种早期预警评分系统对多发伤患者病情严重程度的评估效果差异。方法选取2019年2月—2020年9月我院急诊抢救室收治的195例多发伤患者为研究对象,采用创伤指数(trauma index,TI)评分将患者分为轻度创伤组、中度创伤组和重度创伤组,通过改良早期预警评分(modified early waring score,MEWS)、英国国家早期预警评分(UK national early warning score,NEWS)和重要性早期预警评分系统(vital pac early warning score,ViEWS)对患者进行病情评估,使用ROC曲线比较三种评分工具对患者病情变化的预测能力。结果轻度、中度和重度多发伤患者的MEWS、NEWS和ViEWS评分结果比较,差异有统计学意义(P<0.05),MEWS、NEWS和ViEWS的分值随患者病情加重而提高,其相关系数分别为0.774、0.653和0.782;在对中度创伤组患者的评估中,MEWS与NEWS的ROC曲线下面积(area under curve,AUC)比较,差异有统计学意义(Z=2.138,P<0.05),MEWS评分的AUC值(0.853)和约登指数(0.540)均为三者中最高;在对重度创伤组患者的评估中,NEWS与ViEWS、MEWS与NEWS以及三者AUC的比较,差异均有统计学意义(P<0.05),ViEWS评分的AUC值(0.984)和约登指数(0.908)均最大。结论三种早期预警评分系统之中,MEWS可更准确地反映中度创伤多发伤患者的病情,ViEWS可更准确地反映重度创伤多发伤患者的病情。

Objective To explore the difference of evaluation effects of three early warning scoring systems on the severity of patients with multiple injury.Methods 195 patients with multiple injuries admitted to the emergency room of our hospital from February 2019 to September 2020 were selected as the research objects,and the patients were divided into mild injury group,moderate injury group and severe injury group by trauma index(TI)score.The modified early waring score(MEWS),UK national early warning score,(NEWS)and vital pac early warning score(ViEWS)were used to evaluate the patients'condition,and receiver operator characteristic(ROC)curve was used to compare the prediction ability of the three scoring tools for the changes of patients'condition.Results There were statistically significant differences in the scores of MEWS,NEWS and ViEWS in patients with mild,moderate and severe multiple injuries(P<0.05).The scores of MEWS,NEWS and ViEWS increased with the aggravating of patients'condition,and their correlation coefficients were 0.774,0.653 and 0.782.In the evaluation of patients in the moderate injury group,the Area Under Curve(AUC)of MEWS and NEWS showed statistically significant difference(Z=2.138,P<0.05).AUC value of MEWS score(0.853)and Jorden index(0.540)were the highest among the three.In the evaluation of patients in the severe trauma group,there were statistically significant differences between NEWS and ViEWS,MEWS and NEWS,as well as the AUC of the three groups(P<0.05).AUC values of ViEWS score(0.984)and Jorden index(0.908)were the largest.Conclusion Among the three early warning scoring systems,MEWS can more accurately reflect the condition of patients with moderate multiple injury,while ViEWS can more accurately reflect the condition of patients with severe multiple injury.