CRAMS评分在急性创伤住院患者中的应用研究

目的研究CRAMS（circulation，respiration，abdomen，motor，speech）评分系统评估急性创伤住院患者预后的实用性及可行性。方法回顾性分析急性创伤住院患者1802例的临床资料，分别行CRAMS评分和损伤严重度评分（ISS）。以出院日期为观察终点，结局为观察指标，作出受试者工作特征曲线（ROC曲线），以ISS评分为参照，计算相应的预测指标，比较CRAMS评分预测急性创伤住院患者结局的价值。结果所录入1802例伤员病死率为5．77％；CRAMS评分ROC曲线下面积为0．885（95％CI：0．870～0．900），ISS评分ROC曲线下面积为0．792（95％CI：0．773—0．811），二者具有统计学差异（Z=4．280，P〈0．001）；判断“潜在危重症”的最佳截断点分别为CRAMS≤7分、ISSI〉22分；CRAMS评分对危重症患者死亡预测的灵敏度优于ISS评分（x2=16．910，P〈0．001），特异度低于ISS评分（x2=5．260，P=0．022），准确度与ISS评分无统计学差异（x2=0．693，P=0．405）。结论CRAMS评分对急性创伤住院患者的预后评估具有较高的分辨能力，并优于ISS评分；CRAMS评分操作简便、易于掌握、反映病情及时可靠，有利于院内创伤患者危重症的早期发现与救治。

Application research of CRAMS score in hospitalized patients with acute trauma

Objective To study the practicality and feasibility of CRAMS score in assessing the prognosis of hospitalized patients with acute trauma. Methods Data of 1 802 cases of acute trauma were retrospectively analyzed. All the 1802 patients were evaluated by CRAMS score and Injury Severity Score （ISS）. Receiver operating character istic curve （ ROC curve） was used by taking the date of discharge as the endpoint and the outcome as the observed in dicator. In order to evaluate CRAMS score in predicting prognosis value in hospitalized patients with acute trauma, the corresponding prediction indicators were calculated and 1SS was referenced. Results In the 1 802 wounded patients, the mortality rate was 5.77%. The area under the ROC curve was 0. 885 （95% CI：0. 8700. 900} by the score of CRAMS and 0. 792 （ 95% CI ： 0. 7730. 811 I by the score of ISS, there was statistical difference （ Z = 4. 280, P 〈 0. 001 ） ;the optimal truncation point to judge ＂the potentiality for critically ill patients＂ was CRAMS 7, ISS 1〉22, re spectively; the sensitivity of CRAMS score was superior to ISS score （X2 = 16.910,P 〈 0.001 ）,the specificity of CRAMS score was lower than ISS score（x2 = 5. 260,P=0. 022） , the accuracy of CRAMS and ISS showed no signifi cant difference （ X2 = 0. 693,P = 0. 405 ）. Conclusion CRAMS score has high resolution in the evaluation of disease severity and prognosis for hospitalized patients with acute trauma,which is superior to ISS score;CRAMS score has ad vantages of operating easily and reflecting the condition timely and reliably, which is beneficial for the early detection and treatment of hospitalized trauma patients with critical illness.