国家早期预警评分系统对老年急危重症患者病情的评估作用

目的：应用国家早期预警评分（NEWS）系统对老年急危重症患者急诊病情进行评估，评价NEWS对老年患者病情的评估作用。方法对我院急诊抢救室收治的361例≥60岁老年急危重患者进行NEWS评分，跟踪患者24h内病情变化、急诊转归停留期以及预后，绘制受试者工作特征（ROC）曲线，寻找最佳截点。以最佳截点为界分为低分组和高分组，比较两组间24h内病情变化、入住监护病房和急诊停留期间死亡，以及30d内死亡的发生率。结果 NEWS可预测患者24h内病情变化、急诊转归、预后的ROC曲线下面积（AUC）分别为（0.776±0.043），（0.970±0.011），（0.861±0.039），最佳截断点分别为7分，6分，8分。以6分为最佳截断点，分为高分组与低分组，比较两组之间24h内病情变化、入住监护病房和急诊停留期间死亡，以及30d内死亡的发生率，差异有统计学意义（P＜0.01）。结论 NEWS能有效评估老年急危重症患者病情。

Performance of National Early Warning Score in assessment of acute critical illness in the elderly

ObjectiveToinvestigate theperformance ofNationalEarlyWarningScore（NEWS）in the assessment ofpatient deteriorationfor the elderly with acutecritical illness.MethodsA total of361 elderly patientsat an age of over 60 years with acutecritical illness admitted in our department from October 2013 to March 2014 were enrolled in this study. NEWSsystem was employed toanalyze the patients’ condition. Their unanticipated circumstances within 24 h,intensive care unit（ICU）admission, therapeutic outcomesand prognosis were followed up and recorded. Receiver operating characteristic（ROC） curve was drawnin different conditionsin order to findtheoptimal cut-off value. Then according to the obtainedoptimal cut-off value, the cohort was divided into high NEWS group and low NEWS group. Their unanticipated circumstances within 24 h afteradmission,ICU admission, death inDepartment of Emergency, and mortality within30d were compared betweenthe2 groups.Results The area under ROC curve （AUC）of NEWS was（0.776±0.043）,（0.970±0.011） and（0.861±0.039）, respectively for unanticipated circumstances within 24h,ICU admission （including the death inDepartment ofEmergency） and thedeath within 30d, and their optimal cut-off values were 7, 6 and 8,respectively.When 6 wasset as theoptimalcut-off value,significant differences were seen in above indices between thetwo groups （P＆lt;0.01）.Conclusion NEWS system is effective to assess thecondition of the elderly patientwith acute severe diseases.