改良早期预警评分在预测急性中毒患者预后中的应用

Application of MEWS in prognosis for patients with acute poisoning

目的探讨改良早期预警评分(MEWS)在急性中毒患者预后中的应用价值。方法选取我院急诊科2013年3月至2015年3月收治的420例急性中毒患者,采用前瞻性观察性研究,以患者入院就诊为观察起点,采集相关数据,进行MEWS评分,追踪患者30 d预后,分析不同分数段患者预后情况,并通过ROC曲线探讨MEWS评分预后预测的准确性。结果 0~4分308例,存活305例,死亡3例,病死率为0.97%;5~8分86例,存活37例,死亡49例,病死率为57.0%;≥9分26例,存活0例,死亡26例,病死率为100.0%;MEWS评分对急性中毒患者死亡预测的最佳截断点为4.5分,灵敏度96.2%,特异度89.2%,Youden指数为0.854,ROC曲线下面积AZ=0.982,与零假设(曲线下实面积=0.5)比较,差异有统计学意义(P<0.05)。结论 MEWS评分能够很好地预测急性中毒患者病情及预后,该评分简单、使用,适合在急性中毒患者中使用。

Objective To discuss the application value of modified early warning score(MEWS) in prognosis for patients with acute poisoning.Methods A total of 420 patients with acute poisoning in Department of Emergency in our hospital from March 2013 to March 2015 were selected for the prospective observational study.Taking the patients to the hospital as the observation point,the relevant data was collected,and the MEWS score was performed.The patients were followed up for 30 days to evaluate the prognosis.Different scores of prognosis of patients were analyzed,and the accuracy of prognosis prediction of MEWS score were discussed by ROC curve.Results There were 0~4 score of patients in 308 cases,which survived in 305 cases,died in 3 cases,and fatality rate was 0.97%.There were 5~8 score of patients in 86 cases,which survived in 37 cases,died in 49 cases,and fatality rate was 57.0%.There were ≥9 score of patients in 26 cases,which survived 0 case,died in 26 cases,and fatality rate was 100.0%.The best truncated point of MEWS score for patients with acute poisoning was 4.5,with the sensitivity of 96.2%,specificity of 89.2%,Youden index was 0.854,and the area under ROC curve was AZ=0.982.The difference was statistically significant compared with null hypothesis(real area under the curve of 0.5,P<0.05).Conclusion MEWS score has good predictive value for acute poisoning patients,which is simple and practical.Therefore,it is suitable for use in patients with acute poisoning.