院前指数在急性创伤住院患者中应用价值.docVIP

院前指数在急性创伤住院患者中应用价值 　　DOI：10.3760/cma.j.issn.1671-0282.2013.11.012 　　基金项目：卫生部公益性行业科研专项资助（201002014） 　　作者单位：545005 广西壮族自治区柳州，广西医科大学第四附属医院急诊科 　　通信作者：李兵，Email：drlibing@139.com 　　【摘要】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（χ2=6.975，P=0.008），而特异度、准确度与ISS差异无统计学意义（P0.05）。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。 　　【关键词】 院前指数；创伤；急性；住院患者；损伤严重度评分；病情评估 　　The application value of prehospital index in hospitalized patients with acute trauma GE Wen-han，LI Bing，RUAN Hai-lin，HUANG Fu-wen，YANG Jia-you.Department of Emergency，The Fourth Affiliated Hospital of Guangxi Medical University，Liuzhou 545005，China 　　Corresponding author： LI Bing ， Email：lansehuanghun@126.com 　　【Abstract】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.