Ikeda Masayuki, Matsunaga Takashi, Irabu Noritsugu, Yoshida Shohji
Department of Clinical Research, National Saigata Hospital, Ohgata-machi, Nakakubiki-gun, Niigata 949-3193, Japan.
BMJ. 2002 Oct 12;325(7368):800. doi: 10.1136/bmj.325.7368.800.
To determine whether any vital signs can be used to quickly identify brain lesions in patients with impaired consciousness.
Cross sectional observational study.
Emergency department of an urban hospital, Japan.
529 consecutive patients (mean age 65 years) presenting with impaired consciousness (score <15 on the Glasgow coma scale) during 2000.
The receiver operating characteristic curve was used to quantify the relation between the vital signs on arrival and the final diagnosis of a brain lesion. Stratum specific likelihood ratios were calculated to define strata with optimal discriminating power.
312 (59%) had a brain lesion which accounted for the impaired consciousness. The area under the receiver operating curve for systolic blood pressure was 0.90 (SE 0.01), indicating significantly higher accuracy (P<0.01) in the identification of a brain lesion than using diastolic pressure 0.82 (0.02) or pulse rate 0.63 (0.03). Likelihood ratios for systolic blood pressure lower than 90 mm Hg were less than 0.04, and those for systolic pressure higher than 170 mm Hg were greater than 6.09.
Systolic blood pressure is useful for diagnosing brain lesions in patients with impaired consciousness.
确定是否有任何生命体征可用于快速识别意识障碍患者的脑部病变。
横断面观察性研究。
日本一家城市医院的急诊科。
2000年期间连续529例意识障碍患者（平均年龄65岁，格拉斯哥昏迷量表评分<15分）。
采用受试者工作特征曲线来量化入院时生命体征与脑部病变最终诊断之间的关系。计算分层特异性似然比以确定具有最佳鉴别能力的分层。
312例（59%）患者存在导致意识障碍的脑部病变。收缩压的受试者工作曲线下面积为0.90（标准误0.01），表明在识别脑部病变方面的准确性显著高于舒张压（0.82, 0.02）或脉搏率（0.63, 0.03）（P<0.01）。收缩压低于90 mmHg的似然比小于0.04，收缩压高于170 mmHg的似然比大于6.09。
收缩压有助于诊断意识障碍患者的脑部病变。
