CAJ | 학술논문

目的评估院前指数(PHI)在急性创伤住院患者中的应用价值.方法随机抽取急性创伤住院患者1802例,分别行PHI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,利用受试者工作特征曲线(ROC曲线)找出最佳截断点,以ISS为参照,计算患者相应的预测指标,比较PHI预测急性创伤住院患者预后的价值.结果 PHI与ISS评分ROC曲线下面积分别为0.871 (95％CI:0.855～0.886)、0.792 (95％CI:0.773～0.811),二者差异具有统计学意义(Z=2.674,P=0.007);判断急性创伤住院患者“潜在危重症”的最佳截断点分别为PHI≥4分、ISS≥ 22分;PHI对危重症患者死亡预测的的灵敏度优于ISS(x2=6.975,P=0.008),而特异度、准确度与ISS差异无统计学意义(P＞0.05).结论 PHI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;PHI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.
목적 평고원전지수(PHI)재급성창상주원환자중적응용개치.방법 수궤추취급성창상주원환자1802례,분별행PHI화손상엄중도평분(ISS).이출원일기위관찰종점,결국위관찰지표,이용수시자공작특정곡선(ROC곡선)조출최가절단점,이ISS위삼조,계산환자상응적예측지표,비교PHI예측급성창상주원환자예후적개치.결과 PHI여ISS평분ROC곡선하면적분별위0.871 (95％CI:0.855～0.886)、0.792 (95％CI:0.773～0.811),이자차이구유통계학의의(Z=2.674,P=0.007);판단급성창상주원환자“잠재위중증”적최가절단점분별위PHI≥4분、ISS≥ 22분;PHI대위중증환자사망예측적적령민도우우ISS(x2=6.975,P=0.008),이특이도、준학도여ISS차이무통계학의의(P＞0.05).결론 PHI대급성창상주원환자적예후평고구유교고적분변능력,병우우ISS평분;PHI평분조작간편、역우장악、반영병정급시가고,유리우원내창상환자위중증적조기발현여구치.
Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging "the potential for critically ill patients" when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.