揭示院前快速急诊医学评分（pREMS）的表现：预测评分如何影响创伤性脑损伤（TBI）患者的院内结局：一项回顾性观察队列研究。
Unveiling the performance of the prehospital Rapid Emergency Medicine Score (pREMS): How the predictive score impacts in-hospital outcomes in traumatic brain injury (TBI): A retrospective observational cohort study.
机构信息
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Nursing, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran.
出版信息
BMC Emerg Med. 2024 Aug 2;24(1):139. doi: 10.1186/s12873-024-01063-1.
INTRODUCTION
This study aimed to evaluate the predictive accuracy of the prehospital rapid emergency medicine score (pREMS) for predicting the outcomes of hospitalized patients with traumatic brain injury (TBI) who died, were discharged, were admitted to the intensive care unit (ICU), or were admitted to the operating room (OR) within 72 h.
METHODS
A retrospective cohort analysis was performed on a sample of 513 TBI patients admitted to the emergency department (ED) of Besat Hospital in 2023. Only patients of both sexes aged 18 years or older who were not pregnant and had adequate documentation of vital signs were included in the analysis. Patients who died during transport and patients who were transferred from other hospitals were excluded. The predictive power of the pREMS for each outcome was assessed by calculating the sensitivity and specificity curves and by analyzing the area under the receiver operating characteristic curve (AUROC).
RESULTS
The mean pREMS scores for hospital discharge, death, ICU admission and OR admission were 11.97 ± 3.84, 6.32 ± 3.15, 8.24 ± 5.17 and 9.88 ± 2.02, respectively. pREMS accurately predicted hospital discharge and death (AOR = 1.62, P < 0.001) but was not a good predictor of ICU or OR admission (AOR = 1.085, P = 0.603). The AUROCs for the ability of the pREMS to predict outcomes in hospitalized TBI patients were 0.618 (optimal cutoff point = 7) for ICU admission and OR and 0.877 (optimal cutoff point = 9.5) for hospital discharge and death at 72 h.
CONCLUSION
The results indicate that the pREMS, a new preclinical trauma score for traumatic brain injury, is a useful tool for prehospital risk stratification (RST) in TBI patients. The pREMS showed good discriminatory power for predicting in-hospital mortality within 72 h in patients with traumatic brain injury.
简介
本研究旨在评估院前快速急诊医学评分（pREMS）预测创伤性脑损伤（TBI）住院患者在 72 小时内死亡、出院、入住重症监护病房（ICU）或进入手术室（OR）的结局的预测准确性。
方法
对 2023 年 Besat 医院急诊科收治的 513 例 TBI 患者进行回顾性队列分析。仅纳入年龄在 18 岁及以上、非孕妇且生命体征记录充分的男女患者。排除在转运过程中死亡的患者和从其他医院转来的患者。通过计算灵敏度和特异性曲线，并分析受试者工作特征曲线（ROC）下的面积（AUROC）来评估 pREMS 对每个结局的预测能力。
结果
出院、死亡、入住 ICU 和进入 OR 的平均 pREMS 评分为 11.97±3.84、6.32±3.15、8.24±5.17 和 9.88±2.02。pREMS 能准确预测出院和死亡（AOR=1.62，P<0.001），但不能很好地预测 ICU 或 OR 入住（AOR=1.085，P=0.603）。pREMS 预测住院 TBI 患者结局的 AUROC 为 0.618（最佳截断点为 7）用于 ICU 入住和 OR，0.877（最佳截断点为 9.5）用于 72 小时内的出院和死亡。
结论
结果表明，pREMS 是一种新的创伤性脑损伤的临床前创伤评分，是 TBI 患者院前风险分层（RST）的有用工具。pREMS 在预测创伤性脑损伤患者 72 小时内院内死亡率方面具有良好的鉴别能力。
Zotero 插件