4种评分系统判断口腔癌患者术后气管切开需求的准确性评价

Predictive value of four scoring systems on judging the need for tracheostomy in patients with oral cancers

目的:比较Kruse评分、Cameron评分、CASST评分、TRACHY评分判断口腔癌患者术后气管切开需求的效能。方法:回顾性分析2017年12月—2021年7月南京医科大学第一附属医院口腔颌面外科收治的口腔癌患者的临床资料。将临床资料转换为各评分系统得分,根据推荐阈值进行计算评估。绘制受试者工作特征曲线(ROC),根据约登指数调整最佳阈值以重新评估,使用曲线下面积(AUC)比较4种评分的预测效能。采用SPSS 26.0软件包、MedCalc 20.0统计软件对数据进行统计学分析。结果:共纳入口腔癌患者235例,气管切开率为9.8%(23/235)。所有患者术后未行紧急外科气道管理,均在病情稳定后出院。所有评分调整前、后均显示较差的阳性预测值(0.28~0.4/0.19~0.45),敏感度为0.39~0.91/0.87~0.91,特异度为0.75~0.93/0.61~0.88。AUC从大到小依次为Cameron、TRACHY、CASST、Kruse评分,其中Cameron与Kruse评分(Z=2.014,P<0.05)、Cameron评分与CASST评分之间(Z=1.996,P<0.05)有显著差异。结论:4种评分系统在判断口腔癌患者术后气管切开需求方面存在不足,可能导致更高的气管切开率。

PUPPOSE:This study was to assess and compare the predictive value of Kruse,Cameron,CASST and TRA-CHY tracheostomy scoring system on the need for tracheostomy in patients with oral cancers.METHODS:A retrospective analysis was conducted of clinical data of patients with oral cancers admitted to the Department of Oral and Maxillofacial Surgery,First Affiliated Hospital of Nanjing Medical University from December 2017 to July 2021.The clinical data were converted into total score of each scoring system,and the calculation and assessment were examined based on the recommended threshold.Receiver operating characteristic curve(ROC)analysis was used to examine the optimal threshold to reassess according to Youden index.The predictive value was compared by applying the area under receiver operating curve(AUC).The data were analyzed using SPSS 26.0 software package and MedCalc 20.0 software.RESULTS:Two hundred and thirty five cases were included in this retrospective study and the rate of tracheotomy rate was 9.8%(23/235).No emergency surgical airway management was performed after operation,and all patients were discharged with stable condition.All score systems performed poor positive predictive value before or after adjustment(0.28-0.4/0.19-0.45),the sensitivity was 0.39-0.91/0.87-0.91,the specificity was 0.75-0.93/0.61-0.88.AUC from greater to smaller was arranged as Cameron,TRACHY,CASST,Kruse tracheostomy scoring systems.There was significant difference of AUC between Cameron and Kruse scoring system(Z=2.014,P<0.05),Cameron and CASST scoring system(Z=1.996,P<0.05).CONCLUSIONS:Instead of effectively judging the need for tracheotomy,these four scoring systems may lead to a higher tracheostomy rate.