不同评分系统对颅脑外伤患者近期预后预测效能的对比分析

  目的  探讨4种常用的评分方式对颅脑外伤(TBI)患者病情预后评估分效能。   方法  选择2017年1月—2018年6月温州医科大学附属第二医院接诊的TBI患者149例，按照患者入院后28 d时预后将所有患者分为预后良好和预后不良2种情况。分析2组患者入院时一般资料并根据格拉斯哥昏迷指数(GCS)、急性生理学及慢性健康状况评分(APACHEⅡ)、改良早期预警评分(MEWS)和分流早期预警评分(TEWS)对患者入院时状态进行评分，而后采用logistic回归分析判断影响患者预后的因素，并使用ROC曲线评价4种评分对患者预后的预测效能。   结果  患者出院时预后不良例数为42例，预后不良率为28.18%。预后良好患者颅内出血率、GCS、APACHEⅡ、MEWS、TEWS均显著低于预后不良患者，伤情显著优于预后不良患者(均P < 0.05)。APACHEⅡ、MEWS及TEWS为影响患者预后的独立危险因素。ROC分析结果显示，APACHEⅡ及TEWS对TBI患者预后的AUC显著大于MEWS(均P < 0.05)，APACHEⅡ及TEWS对TBI患者预后的AUC比较差异无统计学意义(P>0.05)。   结论  TWES与APACHEⅡ对于TBI患者预后均有较好的预测效能，但TWES预测阳性可信度较好，可以将之运用于TBI患者入院时评估中。 

Comparative analysis of four scoring systems in predicting the short-term prognosis of patients with traumatic brain injury

Objective To investigate the efficacy of four scoring methods in evaluating the prognosis of patients with traumatic brain injury(TBI).Methods A total of 149 patients with TBI who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to June 2018 were selected.According to the prognosis at 28 days after admission,all patients were divided into two types:good prognosis and poor prognosis.The general data of the two groups of patients at admission was analyzed and the patients’admission status was scored based on the Glasgow Coma Index(GCS),Acute Physiology and Chronic Health Status Score(APACHEⅡ),Modified Early Warning Score(MEWS),and Triage Early Warning Score(TEWS).Then logistic regression analysis was used to determine the factors affecting the prognosis of the patients,and the ROC curve was used to evaluate the predictive power of the four scores on the prognosis of the patients.Results The number of patients with poor prognosis at the time of discharge was 42,and the poor prognosis rate was 28.18%.The intracranial hemorrhage rate,GCS,APACHEⅡ,MEWS,and TEWS of patients with good prognosis were significantly lower than those with poor prognosis,and the injuries were significantly better than those with poor prognosis(all P<0.05).The APACHEⅡ,MEWS and TEWS were the independent risk factors that affect the prognosis of patients(all P<0.05).The results of ROC analysis showed that the prognosis of APACHEⅡand TEWS for TBI patients were significantly greater than that of MEWS(both P<0.05),and the prognosis of APACHEⅡand TEWS for TBI patients were not significantly different(P>0.05).Conclusion Both TWES and APACHEⅡhave better predictive power for the prognosis of TBI patients,but the positive predictive reliability of TWES is good,and they can be used in TBI patients’admission evaluation.