Zhou Zhongyuan, Mo Shijun, Lu Zengxue, Liu Shengnan, Peng Yongjun
Department of Emergency Medicine, Xing'an County People's Hospital, Guilin 541300, Guangxi Zhuang Autonomous Region, China. Corresponding author: Zhou Zhongyuan, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 May;35(5):533-537. doi: 10.3760/cma.j.cn121430-20220704-00627.
To establish a new emergency dynamic score (EDS) method based on modified early warning score (MEWS) combined with clinical symptoms, rapidly available examination results and bedside examination data in the emergency department, and to observe its applicability and feasibility in the clinical application of emergency department.
A total of 500 patients admitted to the department of emergency of Xing'an County People's Hospital from July 2021 to April 2022 were selected as research objects. After admission, EDS and MEWS scores were performed first, and then acute physiology and chronic health evaluation II (APACHE II) was performed retrospectively, and the prognosis of patients was followed up. The difference of short-term mortality in patients with different score segments of EDS, MEWS and APACHE II were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the prognostic value of various scoring methods in critically ill patients.
The mortality of patients in different score groups of each scoring method increased with the increase of the score value [The mortality of 0-1, 2-3, 4-5, 6-7 and ≥ 8 of MEWS were 1.9% (3/159), 2.9% (6/208), 12.4% (11/89), 29.0% (9/31) and 61.5% (8/13), respectively. The mortality of EDS stage 1 weighted MEWS score 0-3, 4-6, 7-9, 10-12 and ≥ 13 were 0 (0/49), 3.2% (8/247), 6.6% (10/152), 31.9% (15/47) and 80.0% (4/5), respectively. The mortality of EDS stage 2 clinical symptom score 0-4, 5-9, 10-14, 15-19, ≥ 20 were 0 (0/13), 0.4% (1/235), 3.6% (6/165), 26.2% (17/65), 59.1% (13/22), respectively. The mortality of EDS stage 3 rapid test data score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 0 (0/16), 0.6% (1/159), 4.6% (6/131), 13.7% (7/51) and 65.0% (13/20), respectively. The mortality of patients with APACHE II score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 1.9% (1/53), 0.4% (1/277), 4.6% (5/108), 34.2% (13/38) and 70.8% (17/24), respectively, all P < 0.01]. When the MEWS score was more than 4, the specificity was 87.0%, the sensitivity was 67.6%, and the maximum Youden index was 0.546, which was the best cut-off point. When the weighted MEWS score of EDS in the first stage was greater than 7, the specificity of predicting the prognosis of patients was 76.2%, the sensitivity was 70.3%, and the maximum Youden index was 0.465, which was the best cut-off point. When clinical symptom score of EDS in the second stage was more than 14, the specificity and sensitivity of predicting the prognosis of patients were 87.7% and 81.1%, respectively, and the maximum Youden index was 0.688, which was the best cut-off point. When the third stage rapid test of EDS reached 15 points, the specificity of predicting the prognosis of patients was 70.9%, and the sensitivity was 96.3%, and the maximum Youden index was 0.672, which was the best cut-off point. When APACHE II score was higher than 16, the specificity was 87.9%, the sensitivity was 86.5%, and the maximum Youden index was 0.743, which was the best cut-off point. ROC curve analysis showed that: EDS score in the stage 1, 2 and 3, MEWS score and APACHE II score can predict the short-term mortality risk of critically ill patients. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.815 (0.726-0.905), 0.913 (0.867-0.959), 0.911 (0.860-0.962), 0.844 (0.755-0.933) and 0.910 (0.833-0.987), all P < 0.01. In terms of the differential ability to predict the risk of death in the short-term, the AUC in the second and third stages of EDS were highly close to APACHE II score (0.913, 0.911 vs. 0.910), and significantly higher than MEWS score (0.913, 0.911 vs. 0.844, both P < 0.05).
EDS method can dynamically evaluate emergency patients in stages, and has the characteristics of fast, simple, easy to obtain test and inspection data, which can facilitate emergency doctors to evaluate emergency patients objectively and quickly. It has strong ability to predict the prognosis of emergency patients, and is worth popularizing in emergency departments of primary hospitals.
基于改良早期预警评分（MEWS），结合急诊科临床症状、快速可得的检查结果及床旁检查数据，建立一种新的急诊动态评分（EDS）方法，并观察其在急诊科临床应用中的适用性与可行性。
选取2021年7月至2022年4月兴安县人民医院急诊科收治的500例患者作为研究对象。入院后首先进行EDS和MEWS评分，然后回顾性进行急性生理与慢性健康状况评价Ⅱ（APACHEⅡ）评分，并对患者预后进行随访。比较EDS、MEWS及APACHEⅡ不同评分段患者的短期死亡率差异。绘制受试者工作特征曲线（ROC曲线），评估各评分方法对危重症患者的预后价值。
各评分方法不同评分组患者的死亡率均随分值增加而升高[MEWS评分0 - 1、2 - 3、4 - 5、6 - 7及≥8组的死亡率分别为1.9%（3/159）、2.9%（6/208）、12.4%（11/89）、29.0%（9/31）及61.5%（8/13）。EDS第1阶段加权MEWS评分0 - 3、4 - 6、7 - 9、10 - 12及≥13组的死亡率分别为0（0/49）、3.2%（8/247）、6.6%（10/152）、31.9%（15/47）及80.0%（4/5）。EDS第2阶段临床症状评分0 - 4、5 - 9、10 - 14、15 - 19及≥20组的死亡率分别为0（0/13）、0.4%（1/235）、3.6%（6/165）、26.2%（17/65）及59.1%（13/22）。EDS第3阶段快速检查数据评分0 - 6、7 - 12、13 - 18、19 - 24及≥25组的死亡率分别为0（0/16）、0.6%（1/159）、4.6%（6/131）、13.7%（7/51）及65.0%（13/20）。APACHEⅡ评分0 - 6、7 - 12、13 - 18、19 - 24及≥25组患者的死亡率分别为1.9%（1/53）、0.4%（1/277）、4.6%（5/108）、34.2%（13/38）及70.8%（17/24），均P < 0.01]。当MEWS评分大于4时，特异性为87.0%，敏感性为67.6%，最大约登指数为0.546，为最佳截断点。当EDS第1阶段加权MEWS评分大于7时，预测患者预后的特异性为76.2%，敏感性为70.3%，最大约登指数为0.465，为最佳截断点。当EDS第2阶段临床症状评分大于14时，预测患者预后的特异性及敏感性分别为87.7%和81.1%，最大约登指数为0.688，为最佳截断点。当EDS第3阶段快速检查达到15分时，预测患者预后特异性为70.9%，敏感性为96.3%最大约登指数为0.672，为最佳截断点。当APACHEⅡ评分高于16时，特异性为87.9%，敏感性为86.5%，最大约登指数为0.743，为最佳截断点。ROC曲线分析显示：EDS第1、2、3阶段评分、MEWS评分及APACHEⅡ评分均可预测危重症患者的短期死亡风险。ROC曲线下面积（AUC）及95%置信区间（95%CI）分别为0.815（0.726 - 0.905）、0.913（0.867 - 0.959）、0.911（0.860 - 0.962）、0.844（0.755 - 0.933）及0.9
