He Fan, Liu Xu-xiang, Zhu Li-ye, Jin Dong-hui, Zhang Guo-hong, Zhu Bao-ping, Zhang Li-jie, Ma Hui-lai
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2010 May;31(5):563-6.
To explore the score criteria of severe hand, foot and mouth disease (HFMD) cases and to provide evidence for unified criteria and treatment on severe HFMD cases.
All severe cases and partial mild cases reported by two designated hospitals of HFMD in Fuyang during March to June, 2008 were scored by the methods of criteria constructed in advance. ROC curve was adopted to evaluate the score criteria and the gold standard was defined according to ICU, intubation and clinical outcomes, etc. Sensitivity, specificity and Youden's index were used to determine the division scores on critical, severe and mild cases.
97% of the cases (34 cases) were scored less than 6 points. 88% of cases (24 cases) who were intubated or mechanical ventilated had the scores of 6 points or higher. 79% of deaths (11 cases) were scored 10 points or higher. The area of receiver operation characteristic (ROC) curve was 0.90 (95%CI: 0.83 - 0.98) between severe and mild cases and the area of ROC curve was 0.95 (95%CI: 0.92 - 0.98) between critical and severe, mild cases. When comprehensively considering the sensitivity and specificity, severe cases were best judged when score was 4 points (sensitivity, specificity and Youden's index were 0.94, 0.68 and 0.62 respectively). When score was 6 points, critical cases were judged very well (sensitivity, specificity and Youden's index were 0.92, 0.84 and 0.76 respectively).
Score criteria could be quantified to determine the degree of seriousness and with high-value for diagnosis on HFMD.
探讨重症手足口病（HFMD）病例的评分标准，为重症HFMD病例的统一标准及治疗提供依据。
采用预先构建的标准方法，对2008年3月至6月阜阳市两家手足口病定点医院报告的所有重症病例及部分轻症病例进行评分。采用ROC曲线评估评分标准，根据入住重症监护病房（ICU）、插管及临床结局等确定金标准。采用灵敏度、特异度及约登指数确定危重症、重症及轻症病例的分界分值。
97%的病例（34例）评分低于6分。88%接受插管或机械通气的病例（24例）评分在6分及以上。79%的死亡病例（11例）评分在10分及以上。重症与轻症病例之间的受试者操作特征（ROC）曲线面积为0.90（95%CI：0.83 - 0.98），危重症与重症、轻症病例之间的ROC曲线面积为0.95（95%CI：0.92 - 0.98）。综合考虑灵敏度和特异度，当评分为4分时，重症病例判断最佳（灵敏度、特异度和约登指数分别为0.94、0.68和0.62）。当评分为6分时，危重症病例判断良好（灵敏度、特异度和约登指数分别为0.92、0.84和0.76）。
评分标准可量化判断手足口病的严重程度，对诊断具有较高价值。
