CAJ | 학술논문

目的本研究探讨了英国国家早期预警评分(national early warning score,NEWS)对我国不同疾病的老年急诊患者死亡的预测价值.方法多中心前瞻性研究.以我国不同地区的九所三甲医院在2013年10月至2014年5月之间急诊就诊的不同疾病老年患者作为研究对象,现场采集进入急诊的数据.进行NEWS评分,以急诊就诊期间的死亡为观察终点,按转归分为死亡组和存活组.计量资料为非正态分布,两组间比较采用两独立样本秩和检验;计数资料组间比较采用x2检验.绘制NEWS评分对所有患者急诊死亡预测的工作特征曲线(ROC曲线),计算约登指数,以最大约登指数时的评分为临界值(cut off).分别绘制各病人群使用NEWS评分进行死亡预测的ROC曲线以评价NEWS评分对不同疾病死亡预测的分辨度,并以Hosmer-Lemeshow拟合优度检验评价NEWS的校准度.以P＜0.05为差异具有统计学意义.结果共收集了1 528份的进入急诊的数据.研究发现NEWS对我国老年患者的急诊死亡预测的ROC曲线下面积(95％ CI)为0.834(0.778～0.890),其中对呼吸系统、消化系统疾病患者死亡预测的ROC曲线下面积(95％ CI)分别为0.885 (0.816 ～0.954)、0.858 (0.737～0.979),而对于心血管系统患者的ROC曲线下面积(95％ CI)则相对较低,为0.798 (0.503～1.000).结论 NEWS对我国急诊老年患者具有很好的预测价值,其中对呼吸系统疾病患者的预测能力较强,但对于心血管系统疾病患者的预测能力则相对较弱,因此我们还可以进一步增加相应的预测参数以提高早期预警评分的预测能力.
목적 본연구탐토료영국국가조기예경평분(national early warning score,NEWS)대아국불동질병적노년급진환자사망적예측개치.방법 다중심전첨성연구.이아국불동지구적구소삼갑의원재2013년10월지2014년5월지간급진취진적불동질병노년환자작위연구대상,현장채집진입급진적수거.진행NEWS평분,이급진취진기간적사망위관찰종점,안전귀분위사망조화존활조.계량자료위비정태분포,량조간비교채용량독립양본질화검험;계수자료조간비교채용x2검험.회제NEWS평분대소유환자급진사망예측적공작특정곡선(ROC곡선),계산약등지수,이최대약등지수시적평분위림계치(cut off).분별회제각병인군사용NEWS평분진행사망예측적ROC곡선이평개NEWS평분대불동질병사망예측적분변도,병이Hosmer-Lemeshow의합우도검험평개NEWS적교준도.이P＜0.05위차이구유통계학의의.결과 공수집료1 528빈적진입급진적수거.연구발현NEWS대아국노년환자적급진사망예측적ROC곡선하면적(95％ CI)위0.834(0.778～0.890),기중대호흡계통、소화계통질병환자사망예측적ROC곡선하면적(95％ CI)분별위0.885 (0.816 ～0.954)、0.858 (0.737～0.979),이대우심혈관계통환자적ROC곡선하면적(95％ CI)칙상대교저,위0.798 (0.503～1.000).결론 NEWS대아국급진노년환자구유흔호적예측개치,기중대호흡계통질병환자적예측능력교강,단대우심혈관계통질병환자적예측능력칙상대교약,인차아문환가이진일보증가상응적예측삼수이제고조기예경평분적예측능력.
Objective To assess the performance of NEWS for emergency elderly patients with different diseases in China.MethodsA prospective cohort study was carried out by recruiting elderly patients with different diseases from nine hospitals across China.Data of elderly patients admitted between 1 st October, 2013 and 31 May, 2014 were collected and the patients were assessed onsite by using NEWS.The in-hospital death was the ultimate observation.The patients with in-hospital death were compared to those alive with regard to their initial physiological parameters by using Mann-Whitney U test, and Chi-square analysis was applied to Yates' continuity correction.The data were used to create receiver operator characteristic curve (ROC) so that the effectiveness of the scores in determining outcome could be assessed.The different areas under the curve (AUROC) were compared according to the method of Hanley and McNeil.Patients were categorized into different groups according to their primary diseases.Each group's ROC curves were created to assess the effectiveness of the scores among different diseases in determining outcome.Calibration was assessed by using the Hosmer-Lemeshow (H-L) test.P ＜ 0.05 was considered significant.Results Data from 1 528 elderly patients were collected.The AUROC (95％ CI) for the NEWS ability to predict in-hospital death were 0.834 (0.778-0.890).For patients with respiratory, and gastrointestinal diseases, NEWS had good discrimination, as the AUROCs (95％ CI) for NEWS ability to predict mortality were 0.885 (0.816-0.954), and 0.858 (0.737-0.979), respectively.While for patients with cardiovascular diseases, the discrimination of NEWS was not so good, as the AUROCs (95％ CI) for NEWS ability to predict mortality was 0.798 (0.503-1.000).Conclusions The performance of NEWS for emergency elderly patients is valid and reliable.For patients with respiratory, gastrointestinal diseases, NEWS had good performance of discrimination to predict mortality.However, for patients with cardiovascular diseases, the discrimination of NEWS was not so good.Therefore, some corresponding parameters should be added to NEWS to improve its effectiveness of predicting mortality.