aDepartment of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Chonbuk National University Hospital, Jeonju bNational Cancer Control Institute, National Cancer Center, Goyang, Korea.
Eur J Emerg Med. 2014 Jun;21(3):199-205. doi: 10.1097/MEJ.0b013e32836192d6.
The aim of this study was to compare the predictive value of the VitalPAC Early Warning Score-lactate (ViEWS-L) score with that of the trauma and injury severity score (TRISS), which is a pre-existing risk scoring system used in trauma patients.
The patients were blunt trauma victims admitted consecutively to the study hospital between 1 April 2010 and 31 March 2011, who were 15 years or older and had an injury severity score of 9 or higher. The lactate level, the ViEWS and revised trauma score upon arrival at the emergency department, and the injury severity score and TRISS were evaluated. The ViEWS-L score was calculated according to the formula: ViEWS-L=ViEWS+lactate (mmol/l). The ability to predict mortality was assessed by area under the receiver operating characteristic curve (AUC) analysis and calibration analysis.
A total of 299 patients were available for analysis, of whom 33 died (11.0%). The median ViEWS-L score was 3.7 (interquartile range:1.8-6.4) and the median TRISS was 96.8 (interquartile range: 93.4-98.6). The ViEWS-L score was better than TRISS at predicting hospital mortality (AUC, 0.838; 95% confidence interval, 0.771-0.906 vs. AUC, 0.734; 95% confidence interval, 0.635-0.833, P=0.031). Calibration of the ViEWS-L score (χ=11.13, P=0.194) was good but that of TRISS was not (χ=16.97, P=0.018).
The prognostic value of the ViEWS-L score in terms of discrimination was better than that of TRISS in the blunt trauma patients admitted to the emergency department with an injury severity score of 9 or higher, and the ViEWS-L score showed good calibration.
本研究旨在比较 VitalPAC 早期预警评分-乳酸（ViEWS-L）与创伤和损伤严重程度评分（TRISS）的预测价值，TRISS 是一种用于创伤患者的现有风险评分系统。
本研究纳入了 2010 年 4 月 1 日至 2011 年 3 月 31 日连续入住研究医院的钝器创伤患者，年龄在 15 岁及以上，损伤严重程度评分为 9 分或更高。评估了入院时的乳酸水平、ViEWS 和修订后的创伤评分以及损伤严重程度评分和 TRISS。根据公式计算 ViEWS-L 评分：ViEWS-L=ViEWS+乳酸（mmol/L）。通过受试者工作特征曲线（ROC）下面积（AUC）分析和校准分析评估预测死亡率的能力。
共 299 例患者可进行分析，其中 33 例死亡（11.0%）。ViEWS-L 评分中位数为 3.7（四分位距：1.8-6.4），TRISS 中位数为 96.8（四分位距：93.4-98.6）。ViEWS-L 评分预测院内死亡率优于 TRISS（AUC：0.838；95%置信区间：0.771-0.906 与 AUC：0.734；95%置信区间：0.635-0.833，P=0.031）。ViEWS-L 评分的校准良好（χ=11.13，P=0.194），而 TRISS 的校准不佳（χ=16.97，P=0.018）。
在损伤严重程度评分为 9 分或更高的因钝器创伤而被收入急诊科的患者中，ViEWS-L 评分在区分预后方面的预测价值优于 TRISS，且 ViEWS-L 评分具有良好的校准度。
