急诊医学系列专题：如何合理应用急诊评分——SCS评分、SIRS评分和APACHEⅡ评分在急诊危重患者预后评估中的比较研究

目的 探讨SCS评分、SIRS评分和APACHEⅡ评分在评估急诊危重患者预后中的作用,并进行对比研究.方法 对我院急诊重症监护病房2011年9月-2012年9月收治的412例危重患者进行SCS评分、SIRS评分和APACHEⅡ评分,追踪患者预后,并根据当次入院后生存与死亡情况,比较3种评分与患者预后的相关性;通过ROC曲线下面积比较3种评分系统预测急诊危重患者预后的准确性.结果 SCS评分、SIRS评分和APACHEⅡ评分的分值越高,病死率越高;3种评分的ROC曲线下面积分别为0.801、0.692和0.865.结论 SCS评分、SIRS评分和A-PACHEⅡ评分系统均能预测患者预后,准确度APACHEⅡ＞SCS＞ SIRS.但从成本效益方面考虑,SCS评分更适用于急诊危重患者的早期预后评估.

A Comparative Study on SCS Score,SIRS Score and APACHEⅡ Score in Prognosis Evaluation of Critically-ill Patients in Emergency Department

Objective To explore effects of simple clinical score （SCS）,systemic inflammatory response syndrome （SIRS） score and acute physiology and chronic health evaluation （APACHEⅡ） score in prognosis evaluation of critical patients in emergency department,and to carry out a comparative study.Methods A total of 412 critical patients during September 2011 and September 2012 undertook SCS,SIRS and APACHEⅡ score tests,and prognoses were also evaluated.Correlations between the scores from the three methods and prognoses were compared according to the survival and death conditions at and after the admission ; the accuracy of evaluating the prognoses with three scoring systems were compared by areas under the ROC curve.Results Mortality rates increased with the increasing scores of SCS,SIRS score and APACHEⅡ score; areas under ROC curve of SCS,SIRS score and APACHEⅡ score were 0.801,0.692 and 0.865 respectively.Conclusion All the three scoring systems can predict prognoses of critically-ill patients,and accuracy from high to low is sequenced as APACHEⅡ,SCS and SIRS,but SCS maybe more suitable in prognosis evaluation of critically-ill patients in emergency in terms of the cost-effectiveness.