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改良早期预警评分系统(MEWS)在神经外科手术或干预后患者病情及预后评估中的应用

Application of Modified Early Warning Score System (MEWS) in the Assessment of Disease Condition and Prognosis of Patients After Neurosurgical Procedure or Intervention.

作者信息

Liu Ping, Xu Jiao, Liu Yuhua, Wang Xuexuan, Tan Qili, Wang Ying

机构信息

Neurosurgery Department, Chinese People's Liberation Army Special Medical Center, Chongqing, 400042, People's Republic of China.

Nursing Department, Renji Hospital, School of Medicine, Chongqing University, Chongqing, 400062, People's Republic of China.

出版信息

Risk Manag Healthc Policy. 2025 Aug 18;18:2693-2699. doi: 10.2147/RMHP.S532103. eCollection 2025.

Abstract

OBJECTIVE

To evaluate the safety and clinical utility of the corrected Modified Early Warning Score (MEWS) system in predicting postoperative clinical deterioration and long-term prognosis in neurosurgical patients.

METHODS

A prospective cohort study was conducted on 344 neurosurgical patients admitted between December 2021 and April 2022. Physiological parameters including axillary temperature, respiratory rate, heart rate, systolic blood pressure, arterial oxygen saturation, and consciousness level were systematically recorded. Patients were monitored for clinical deterioration and final outcomes over a 90-day postoperative period. Receiver operating characteristic (ROC) curve analysis was performed with 90-day mortality as the primary endpoint.

RESULTS

The study demonstrated a significant correlation between elevated corrected MEWS scores and clinical severity (p<0.001). ROC analysis revealed excellent predictive accuracy for 90-day mortality (AUC=0.944), with an optimal cutoff value of 4.5 points demonstrating high sensitivity (92.9%) and specificity (82.0%). The maximum Youden's index of 0.749 further confirmed the robust discriminative capacity of this threshold.

CONCLUSION

The corrected MEWS scoring system shows strong predictive validity for postoperative clinical deterioration and long-term outcomes in neurosurgical patients.

摘要

目的

评估校正后的改良早期预警评分(MEWS)系统在预测神经外科患者术后临床病情恶化及长期预后方面的安全性和临床实用性。

方法

对2021年12月至2022年4月收治的344例神经外科患者进行前瞻性队列研究。系统记录包括腋温、呼吸频率、心率、收缩压、动脉血氧饱和度和意识水平在内的生理参数。在术后90天内对患者进行临床病情恶化及最终结局监测。以90天死亡率作为主要终点进行受试者工作特征(ROC)曲线分析。

结果

研究表明校正后的MEWS评分升高与临床严重程度之间存在显著相关性(p<0.001)。ROC分析显示该评分对90天死亡率具有出色的预测准确性(AUC=0.944),最佳截断值为4.5分,灵敏度为92.9%,特异度为82.0%。最大约登指数为0.749,进一步证实了该阈值具有强大的判别能力。

结论

校正后的MEWS评分系统在预测神经外科患者术后临床病情恶化及长期结局方面具有较强的预测效度。

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