改良产科早期预警系统预测孕产妇入住ICU的效果评价

Evaluation of Modified Early Obstetric Warning System as A Predictor of Maternal Intensive Care Unit Admission

目的评价改良产科早期预警系统(MEOWS)在产科人群中预测孕产妇入住重症监护室(ICU)的效果。方法选择2020年4-5月四川大学华西第二医院产科住院的孕产妇235例为研究对象进行回顾性病例对照研究,根据是否转入ICU进行治疗分为试验组和对照组,所有入住ICU的孕产妇纳入试验组,对照组选取同期未入住ICU的住院孕产妇,按照1∶4的比例选择与试验组的年龄(±3年)和孕周(±1周)相匹配的孕产妇。采用MEOWS对两组孕产妇住院期间的各项参数进行评估和颜色标识后,评价MEOWS的预测效果。结果47名孕产妇转入ICU进行治疗,其中42名触发MEOWS。MEOWS预测ICU入住的敏感性为89.36%(95%CI 76.90%~96.45%);特异性为64.89%(95%CI 57.61%~71.70%);阳性预测值和阴性预测值分别为38.89%(95%CI 29.66%~48.75%)和96.06%(95%CI 91.55%~98.71%)。结论MEOWS对需要转入ICU的孕产妇有良好的早期识别能力,该预警系统应用快捷简单,预测性能好,可在产科普通病房推广使用。

Objective To evaluate the performance of the modified early obstetric warning system(MEOWS)in predicting maternal intensive care unit(ICU)admission in an obstetric population.Methods A retrospective case-control study was conducted on 235 pregnant women and puerperae who were hospitalized in the Obstetrics Department of West China Second Hospital of Sichuan University from April to May 2020.According to whether they were transferred to ICU for treatment,they were divided into experimental group and control group.All pregnant women admitted to ICU were included in the experimental group,and those hospitalized pregnant women who were not admitted to ICU during the same period were selected into the control group to match with the age(±3 years)and gestational age(±1 week)of the experimental group according to the ratio of 1:4.MEOWS system was used to evaluate and color-code the parameters of the two groups of pregnant women during hospitalization.The prediction effect of MEOWS system was evaluated.Results During the study period,47 pregnant women were transferred to ICU for treatment,and 42 of them triggered MEOWS system.The sensitivity of MEOWS in predicting ICU admission was 89.36%(95%CI 76.90%-96.45%);the specificity was 64.89%(95%CI 57.61%-71.7%);the positive and negative predictive values were 38.89%(95%CI 29.66%-48.75%)and 96.06%(95%CI 91.55%-98.71%),respectively.Conclusion MEOWS system has good early identification ability for pregnant women who need to be transferred to ICU.It is fast and simple in application and has good prediction performance,which can be widely used in general obstetric wards.