改良早期预警评分对脑外伤患者死亡的预测价值

目的探索改良早期预警评分法（MEWS）对住院的脑外伤患者死亡的预测价值。方法选取我科的住院脑外伤病例131例作为研究对象。入院即刻作为观察起点,采集相关数据。并对每位患者分别进行格拉斯哥昏迷评分（GCS）评分及MEWS评分,3个月后为观察终点,预后作为观察指标。结果以死亡作为预测指标时,GCS评分截断点是8分。〉8分组与≤8分组病死率差异有统计学意义（P〈0.01）;受度试者操作特征曲线（ROC）下面积Az=0.8863,Se=0.0362,t=10.6823,P〈0.01;敏感性（Sen）=76.70%,特异性（Spe）=82.14%。具有中等强度的预测价值。MEWS评分截断点是5分。〈5分组与≥5分组两者病死率差异有统计学意义（P〈0.01）;ROC曲线下面积Az=0.9264,Se=0.0292,t=14.5938,P〈0.01;Sen=75.00%,Spe=98.02%。具有较强的预测价值。结论MEWS评分对脑外伤患者死亡的预测比GCS评分更具有预测价值。在对脑外伤患者的病情判断、预后预测时,MEWS评分同样是一种可行的手段。

Predictive value study of modified early warning score for death in patients with traumatic brain injury

Objective To study the predictive value of the application of MEWS grade to the death forecast of brain-injured in neurosurgery.Methods According to prefixed choosing and excluding standards,we chose 131 cases of brain-injured in our department.Gathered the data for test as soon as they hospitalized;then we gave grade to every patient according to the GCS and MEWS separately,finished the observation after three months and took the prognosis as the observing index,lastly made the statistical analysis after the data-collection. Results When choose the death as the forecast index, the cut-off of MEWS grade was 5. The mortality between group with 〈 5 and group with ≥ 5 was significant difference （ P 〈 0. 01 ）. Sen = 75.00%, Spe = 98.02% ; and area of ROC＇s curve ： Az = 0. 9264, Se = 0. 0292, t = 14.5938, P 〈 0.01 ; it had a strong predictive value. The cut-off of GCS grade was 8. Also, the mortality between group with ~〈8 and group with 〉 8 was significant difference（P 〈0.01） ;ROC＇s area under the curve Az =0. 8863,Se = 0.0362,t = 10. 6823,P 〈0.01 ;Sen = 76.70 % ,Spe = 82. 14% ;it had a moderate predictive value. Conclusion MEWS score has more predictive value than GCS score in predicating the death of the patient with traumatic brain injury. MEWS score is a good tool as well,when we determine the condition of patients with traumatic brain injury, and their predication of prognosis.