不同量表对脑卒中住院患者跌倒风险的预测效果比较

Comparison of the Predictive Effect of Different Scales on Fall Risk in Stroke Inpatients

目的比较美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力评定量表(ADL)、Morse跌倒评估量表(MFS)、托马斯跌倒风险评估表(STRATIFY)、约翰霍普金斯跌倒风险评估量表(JHFRAT)对脑卒中住院患者跌倒风险的预测效果,为早期评估脑卒中住院患者跌倒风险提供有效工具。方法采用便利抽样法,选取2021年1月-12月北京市某医院康复科和神经内科的149例脑卒中住院患者为研究对象,由不同评估者独立使用上述5种量表对患者进行评分,采用ROC曲线下面积、约登指数、灵敏度、特异度等指标比较5种量表对脑卒中住院患者跌倒风险的预测效果。结果NIHSS、ADL、MFS的ROC曲线下面积分别为0.645、0.413、0.609,与参考线相比差异均无统计学意义(P>0.05);STRATIFY、JHFRAT的ROC曲线下面积分别为0.787、0.899,与参考线相比差异有统计学意义(P<0.05)。STRATIFY、JHFRAT的临界值分别为3分和9分时,约登指数分别为0.40和0.68,预测效果达到最佳,此时STRATIFY、JHFRAT的灵敏度、特异度分别为46.15%、93.38%和100.00%、68.38%。结论NIHSS、ADL、MFS均对脑卒中住院患者跌倒风险预测效果不佳,STRATIFY、JHFRAT均对脑卒中住院患者跌倒风险有预测价值,且JHFRAT预测效果优于STRATIFY。

Objective To compare the predictive effect of the National Institute of Health Stroke Scale(NIHSS),Activity of Daily Living Scale(ADL),Morse Fall Scale(MFS),St Thomas's Risk Assessment Tool in Falling Elderly Inpatients(STRATIFY),and Johns Hopkins Fall Risk Assessment Scale(JHFRAT)on the fall risk of stroke patients during hospitalization to provide an effective tool for early assessment of fall risk in stroke inpatients.Methods 149 stroke inpatients in the Rehabilitation Department and Neurology Department of a hospital in Beijing from January to December 2021 were selected as the research objects by convenience sampling method.Different evaluators independently used the above five scales to score the patients.The area under the ROC curve,Youden index,sensitivity,and specificity were used to compare the predictive effect of the five scales on the fall risk of stroke inpatients during hospitalization.Results The area under the ROC curve of NIHSS,ADL,and MFS were 0.645,0.413,and 0.609 respectively,which had no significant difference compared with the reference line without predictive value(P>0.05).The area under the ROC curve of STRATIFY and JHFRAT was 0.787 and 0.899 respectively,which was statistically significant compared with the reference line(P<0.05).When the critical values of STRATIFY and JHFRAT were 3 and 9,the Youden index were 0.40 and 0.68,respectively,and the prediction effect reached the maximum with the sensitivity and specificity of STRATIFY and JHFRAT of 46.15%,93.38%,and 100.00%,68.38%,respectively.Conclusion NIHSS,ADL,and MFS had poor predictive value for the fall risk of stroke inpatients during hospitalization.STRATIFY and JHFRAT had predictive value,and JHFRAT had better predictive effect than STRATIFY.