改良早期预警评分与国家早期预警评分对老年急诊患者病情评估的比较

摘要

Objective To assess medical emergency in elderly patients by using the modified early warning score (MEWS)and the national early warning score(NEWS)and compare their application values in order to find out which scoring method is more suitable for elderly patients. Methods We enrolled 361 elderly patients(≥60 years old)who were admitted by the Department of Emergency,Chinese PLA General Hospital from October 2013 to March 2014. According to the emergency outcomes,the subjects were divided into general ward group and intensive care unit group;according to the conditions on day 30,the subjects were also divided into death group and survival group. NEWS and MEWS assessments were employed on the subjects. ROC curves were also used to compare the two scoring methods in predicting emergency outcomes and prognosis. Results The general ward group consisted of 239 patients and the intensive care unit group consisted of 122 patients. The intensive care unit group was higher(P < 0. 01)than the general ward group in NEWS,MEWS,respiratory rate and heart rate and was lower( P < 0. 01) in oxyhemoglobin saturation. The areas under ROC curves of NEWS and MEWS that predicted emergency outcomes were(0. 970 ± 0. 011)and(0. 831 ± 0. 025)respectively,with significant difference(Z = 6. 950,P <0. 010)between them. 30 days later,323 subjects who survived were assigned into the survival group and 38 subjects who died were assigned into the death group. The death group was higher( P < 0. 05) than the survival group in NEWS,MEWS, respiratory rate and heart rate and was lower(P < 0. 05) in oxyhemoglobin saturation. ROC curves of NEWS and MEWS that predicted the 30 d prognosis were(0. 861 ± 0. 039) and(0. 789 ± 0. 045) respectively,with significant difference( Z =2. 250,P = 0. 023) between them. Conclusion The NEWS is more accurate and effective in assessing the respiratory and heart rate conditions in elderly patients and is more suitable for the condition assessment of elderly patients with emergent and critical illness.%目的：利用改良早期预警评分（MEWS）和国家早期预警评分（NEWS）对老年急诊患者进行病情评估，比较其应用价值，探讨更适合老年急诊患者的评分方法。方法收集2013年10月—2014年3月中国人民解放军总医院急诊科抢救室收治的老年患者（≥60岁）361例，根据其实际转归情况，分为普通病房组和监护病房组；并以30 d 为终点观察患者预后，分为死亡组和存活组。对患者均进行 NEWS 和 MEWS 评估，使用 ROC 曲线比较两种评分方法预测老年急诊患者转归和预后的能力。结果普通病房组239例，监护病房组122例。监护病房组 NEWS、MEWS、呼吸频率、心率均高于普通病房组，血氧饱和度低于普通病房组（P ＜0.01）。NEWS 与 MEWS 评估老年急诊患者转归的 ROC 曲线下面积分别为（0.970±0.011）和（0.831±0.025），两者比较，差异有统计学意义（ Z ＝6.950，P ＜0.010）。观察终点30 d 时，存活组323例，死亡组38例。死亡组 NEWS、MEWS、呼吸频率、心率均高于存活组，血氧饱和度低于存活组（P ＜0.05）。NEWS 与 MEWS 评估老年急诊患者30 d 预后的 ROC 曲线下面积为（0.861±0.039）和（0.789±0.045），两者比较，差异有统计学意义（Z ＝2.250，P ＝0.023）。结论 NEWS 可更准确、有效反映老年急诊患者呼吸和心率的实际情况，与 MEWS 评分比较，更适合评估老年急重症患者的转归和预后。