创伤评分及其组合评分对急诊创伤患者伤情严重程度的评估作用

Effect of trauma scoring system and combined score on the trauma response of acute trauma ;patients

目的：探讨损伤严重度评分（ISS）、新损伤严重度评分（NISS）、修正创伤评分（RTS）和循环、呼吸、腹部、运动、语言（CRAMS）以及不同组合对创伤患者伤情严重程度的评估作用。方法选取2014年3月至2015年2月收治的创伤患者为研究对象，记录其初始临床信息并计算ISS、NISS、RTS、CRAMS、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）。通过绘制ROC曲线，研究4种创伤评分与APACHEⅡ的拟合情况，并寻找其最佳截断值；之后通过并联方式将生理评分与解剖评分进行联合诊断，并比较联合诊断之后的敏感度与特异度的变化。结果共纳入1020例创伤患者，其中APACHEⅡ≥20分者711例，＜20分者309例，2组患者间相比较在ISS、NISS、CRAMS、RTS方面差异均有统计学意义（U=8.194～11.969，P＜0.05）；ROC曲线分析显示，ISS、NISS、CRAMS、RTS的ROC曲线下面积AUC分别为0.907、0.941、0.768和0.803（均P＜0.05）。联合诊断结果显示不同组合评分均增加对伤情评估的敏感度，但均会减少其特异度。结论4种评分系统中NISS与APACHEⅡ相关性最好，组合评分后可增加对伤情评估的敏感度，但同时会一定程度上降低特异度。

Objective To investigate the performance of Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), CRAMS (circulation, respiration, abdomen, motor, speech)score and combined score on the trauma response of trauma patients. Methods Data of acute trauma patients from March 2014 to February 2015 were chosen as the research object. The clinical information at admission was recorded, and the ISS, NISS, RTS, CRAMS and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were calculated. The optimal cut-off values were looked for the comparability between the four scores and APACHE Ⅱ score were figured out by ROC curve. The joint diagnosis combined physiological score with anatomical score in overlap mode was used for comparing sensitivity and specificity. Results There was a total of 1 020 patients included in the study. APACHEⅡscore ≥20 was found 711 cases, and APACHEⅡ<20 was 309 patients, and there were significant statistic differences in ISS score (U=11.347, P<0.05),NISS score (U=11.969, P<0.05),CRAMS score (U=8.194, P < 0.05) and RTS score (U=8.357, P < 0.05) between two groups. It was showed by ROC curve analysis that the area under the ROC curve (AUC) of ISS, NISS, CRAMS and RTS was 0.907, 0.941, 0.768 and 0.803 (all P<0.05). Compared with the trauma score, combined scores could increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity. Conclusions Of these four scoring systems, NISS has the best correlation with APACHEⅡ. Compared with the trauma score, combined scores can increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity.