| 摘要: |
| ［摘要］ 目的 分析改良早期预警评分（MEWS）和快速急诊内科评分（REMS）对不同系统疾病患者医疗接触24 h内死亡的预测价值。方法 选择2016年1月至2024年8月经广西壮族自治区人民医院急诊抢救室救治、医疗接触后24 h内死亡的281例非创伤患者作为死亡组；在同期于该院急诊抢救室救治并收入内科病房的患者中选取与死亡组前6位死因疾病匹配的542例患者作为存活组。收集患者的临床资料，采用受试者工作特征（ROC）曲线分析MEWS和REMS预测患者医疗接触24 h内死亡的价值。结果 死亡组MEWS和REMS高于存活组，差异有统计学意义（P<0.05）。两种评分均可有效预测急诊内科患者24 h死亡（P<0.05），最佳截断值分别为4分、11分。进一步分层分析结果显示，MEWS预测急性心肌梗死和急性脑梗死患者24 h死亡的曲线下面积（AUC）与REMS相近，特异度较高；预测急性心力衰竭和急性脑出血患者24 h死亡的AUC较大，特异度较高；REMS预测急性主动脉夹层患者24 h死亡的AUC较大，灵敏度较高；两者预测重症肺炎患者24 h死亡的AUC较小，灵敏度及特异度较低。结论 MEWS和REMS对不同疾病患者24 h死亡均有预测价值，但存在差异。MEWS在急性心肌梗死、急性脑梗死、急性心力衰竭及急性脑出血患者24 h死亡的预测价值优于REMS；REMS对急性主动脉夹层患者24 h死亡的识别更敏感。两者对重症肺炎患者24 h死亡的预测效能均较差。 |
| 关键词: 改良早期预警评分 快速急诊内科评分 急诊科 医疗接触24 h内死亡 预测价值 |
| DOI：10.3969/j.issn.1674-3806.2026.08.16 |
| 分类号:R 459.7 |
| 基金项目:广西科技基地和人才专项（编号：桂科AD22035101） |
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| Predictive value of MEWS and REMS for patient mortality within 24 hours of medical contact in different systemic diseases |
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Huang Pingmao1, Ou Limei2, Jia Hongxuan3, Lao Feixiang2, Huang Jun1, Xue Lanfang1, Xiang Shulin4
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1.Department of Emergency, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning 533000, China; 2.Department of Hospital Infection Management, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 3.Department of Emergency, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 4.Department of Critical Care Medicine, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To analyze the predictive value of modified Early Warning Scores(MEWS) and Rapid Emergency Medicine Scores(REMS) for patient mortality within 24 hours of medical contact in different systemic diseases. Methods A total of 281 non-traumatic patients who died within 24 hours of medical contact and were treated in the Emergency Resuscitation Room of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2016 to August 2024 were selected as the death group. Among patients who were treated in the emergency resuscitation room of the same hospital during the same period and subsequently admitted to the internal medicine wards, 542 patients matched with the top 6 causes of death in the death group by diseases were selected as the survival group. The clinical data of the patients were collected. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of MEWS and REMS for patient mortality within 24 hours of medical contact. Results The MEWS and REMS in the death group were higher than those in the survival group, with statistically significant differences(P<0.05). Both scores could effectively predict the death of emergency internal medicine patients within 24 hours(P<0.05), and their optimal cut-off values were 4 points and 11 points, respectively. Further stratified analysis revealed that the area under the curve(AUC) of MEWS for predicting death within 24 hours in patients with acute myocardial infarction and in patients with acute cerebral infarction was comparable to that of REMS, with MEWS showing higher specificity; the AUC of MEWS for predicting death within 24 hours in patients with acute heart failure and in patients with acute cerebral hemorrhage was larger than that of REMS, with MEWS showing higher specificity; the AUC of REMS for predicting death within 24 hours in patients with acute aortic dissection was larger than that of MEWS, with REMS showing higher sensitivity; the AUCs of the two scores for predicting death within 24 hours in patients with severe pneumonia were relatively small and their sensitivity and specificity were relatively high. Conclusion Both MEWS and REMS have predictive value for deaths within 24 hours in patients with different diseases, but differences exist between them. The predictive value of MEWS for deaths within 24 hours in patients with acute myocardial infarction, acute cerebral infarction, acute heart failure and acute cerebral hemorrhage is superior to that of REMS. REMS are more sensitive in identifying death within 24 hours in patients with acute aortic dissection. MEWS and REMS have low efficacy for predicting death within 24 hours in patients with severe pneumonia. |
| Key words: modified Early Warning Scores(MEWS) Rapid Emergency Medicine Scores(REMS) emergency department(ED) patient mortality within 24 hours of medical contact predictive value |
