Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County 613, Taiwan.
Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan.
Medicina (Kaunas). 2023 Mar 11;59(3):556. doi: 10.3390/medicina59030556.
The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated and compared with in-hospital mortality. A total of 336 patients were recruited, of whom 40 died. There is a significant difference between the patients in the mortality group and survival group in terms of the six scoring systems. MEWS had the highest area under the curve (AUC) value (0.82). A subgroup analysis was performed for a total of 180 very elderly patients (i.e., older than 75 years), of whom 27 died. MEWS also had the best predictive performance in this subgroup (AUC, 0.82). This simple, rapid, and obtainable-by-the-bed parameter could assist emergency physicians in risk stratification and decision making for this vulnerable group.
本研究旨在比较六种临床生理基础评分在预测急诊科（ED）老年和超高龄急性上消化道出血（AUGIB）患者住院死亡率的表现，这些评分包括内镜前 Rockall 评分、休克指数（SI）、年龄休克指数（age SI）、快速急性生理学评分（RAPS）、快速急救医学评分（REMS）和改良早期预警评分（MEWS）。本前瞻性研究纳入了 2016 年 7 月至 2021 年 7 月期间因临床诊断为 AUGIB 而就诊于 ED 的年龄大于 65 岁的患者。共纳入 336 例患者，其中 40 例死亡。死亡组和存活组在六种评分系统方面存在显著差异。MEWS 的曲线下面积（AUC）值最高（0.82）。对总共 180 例超高龄患者（即年龄大于 75 岁）进行了亚组分析，其中 27 例死亡。MEWS 在该亚组中也具有最佳的预测性能（AUC，0.82）。这种简单、快速且可床边获取的参数可以帮助急诊医生对这一脆弱人群进行风险分层和决策。
