全国早期预警评分 (NEWS) 和修正预警评分 (MEWS) 在预测院前和急诊科老年患者入院和院内死亡率方面的比较,PeerJ

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全国早期预警评分 (NEWS) 和修正预警评分 (MEWS) 在预测院前和急诊科老年患者入院和院内死亡率方面的比较
PeerJ ( IF 2.3 ) Pub Date : 2019-05-16 , DOI: 10.7717/peerj.6947
Toshiya Mitsunaga _{1,

2} , Izumu Hasegawa ₁ , Masahiko Uzura ₁ , Kenji Okuno ₁ , Kei Otani ₁ , Yuhei Ohtaki ₁ , Akihiro Sekine ₂ , Satoshi Takeda ₁

Affiliation

本研究的目的是评估院前国家早期预警评分 (pNEWS) 和院前修正早期预警评分 (pMEWS) 在预测急诊科老年患者入院和院内死亡率方面的有用性。 (ED)。我们还比较了 pNEWS 与 ED NEWS (eNEWS) 和 ED MEWS (eMEWS) 在预测入院和住院死亡率方面的价值。这项回顾性、单中心观察性研究于 2017 年 4 月 1 日至 2018 年 3 月 31 日在日本千叶市滋庆大学柏医院急诊室进行。所有 65 岁或以上的患者均纳入本研究。pNEWS/eNEWS 来源于七种常见的生理生命体征：呼吸频率、外周血氧饱和度、吸入氧参数的存在、体温、收缩压、脉搏率和警报、对声音有反应、对疼痛有反应、无反应 (AVPU) 评分，而 pMEWS/eMEWS 来自六种常见的生理生命体征：呼吸频率、外周血氧饱和度、体温、收缩压、脉率和 AVPU 评分。通过绘制受试者工作特征 (ROC) 曲线并计算 ROC 曲线下面积 (AUC) 来评估辨别力。入院时的中位数 pNEWS、pMEWS、eNEWS 和 eMEWS 显着高于出院时 (p < 0.001)。非幸存者的 pNEWS、pMEWS、eNEWS 和 eMEWS 中位数显着高于幸存者（p < 0.001）。pNEWS 预测入院的 AUC 为 0.559，pMEWS 为 0.547。pNEWS 和 pMEWS 的 AUC 在预测入院率方面没有显着差异（p = 0.102）。pNEWS 和 pMEWS 预测院内死亡率的 AUC 分别为 0.678 和 0.652。pNEWS 和 pMEWS 的 AUC 在预测院内死亡率方面没有显着差异（p = 0.081）。eNEWS 预测入院的 AUC 为 0.628，eMEWS 为 0.591。在预测入院率方面，eNEWS 的 AUC 显着高于 eMEWS（p < 0.001）。eNEWS 预测院内死亡率的 AUC 为 0.789，eMEWS 为 0.720。在预测院内死亡率方面，eNEWS 的 AUC 显着高于 eMEWS（p < 0.001）。对于入院和住院死亡率，eNEWS的AUC显着大于pNEWS（p < 0.001，p < 0.001），eMEWS的AUC显着大于pMEWS（p < 0.01，p < 0.05）。我们的单中心研究表明，pNEWS 和 pMEWS 作为老年患者入院和院内死亡率的预测指标的实用性较低，而 eNEWS 和 eMEWS 更准确地预测入院和院内死亡率。在引入风险评分系统的院前版本之前，需要多中心研究的证据。而 eNEWS 和 eMEWS 更准确地预测入院和院内死亡率。在引入风险评分系统的院前版本之前，需要多中心研究的证据。而 eNEWS 和 eMEWS 更准确地预测入院和院内死亡率。在引入风险评分系统的院前版本之前，需要多中心研究的证据。

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Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department

The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.

更新日期：2019-05-16

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