Comparative Study Of Three Warning Scores On The Prognosis And Evaluation Of Critical And Severe Patients In Emergency Department

Objective To discuss high risk factors which affect the prognosis of severe and critical patients in Emergency Department(ED), to compare the predictive effect of three warning scores on the prognosis and evaluation of critical and severe patients and to explore the most suitable triage assessment tool of ED in our country.Methods2006cases of severe and critical patients in ED of the Xiangya Hospital of Central South University during May2013to August2013were prospective analyzed. According to the28d prognosis(death or survival),transfer treatment(general ward intensive care unit, operating room) and disposal accepted in the ED (CPR/electric defibrillation, invasive respiratory support),we compared the modified TEWS score,MEWS score and TEWS score in the prediction of the death and condition of severe and critical patients. And area under the ROC curve was used to evaluate the accuracy of these three scores in predicting patient outcomes. Statistical analysis was accomplished through the SPSS13.0and MEDCALC13.0.1.0software.Results1. Single factor analysis showed that:Age(P=0.007), gender(P=0.000), systolic blood pressure(P=0.031), respiratory rate(P=0.001), oxygen saturation(P=0.001), consciousness(P=0.000), mode of admission(P=0.000), trauma(P=0.043), dyspnea(P=0.000), urinary dysfunction(P=0.000) and pain(P=0.000) in1906survival patients group were statistically significant different with that of100death group.2. Multivariate Logistic regression analysis showed that:TEWS score, age, dyspnea and urinary dysfunction were the independent risk factors which influenced the prognosis of the severe and critical patients.3. In each kind of scoring methods, the difference between the survival patients group and the death group,between disposal accepted in the ED (CPR/electric defibrillation and invasive respiratory support) and disposal not accepted in the ED, between being transferred to general wards and being transferred to ICU, between being transferred to general wards and being transferred to operating room were statistically significant respectively (P all=0.000),but the difference between being transferred to ICU and being transferred to operating room were not statistically significant in the MEWS score(P=0.441), the TEWS score(P=0.266) and the modified TEWS score(P=0.479) respectively.4.Compared with MEWS score and TEWS score on prediction of the28d prognosis of the severe and critical patients, the AUCROC of the modified TEWS score were larger than both respectively (P=0.003,0.029).5.Compared with MEWS score and modified TEWS score on prediction of being transferred to general wards of the severe and critical patients, the AUCROC of the TEWS score were larger than both respectively (P=0.000,0.012);compared with MEWS score and TEWS score on prediction of being transferred to ICU of the severe and critical patients, the AUCROC of the modified TEWS score were larger than both, and there was statistically significant different between the modified TEWS score and the MEWS score(P=0.009),but no statistically significant different between the modified TEWS score and the TEWS score(P=0.586);compared with MEWS score and modified TEWS score on prediction of being transferred to operating room of the severe and critical patients, the AUCROC of the TEWS score were larger than both respectively (P=0.033,<0.000).6. Compared with MEWS score and TEWS score on prediction of CPR/electric defibrillation accepted in the ED of the severe and critical patients, the AUCROC of the modified TEWS score were larger than both respectively (P=0.008,0.005); compared with MEWS score and TEWS score on prediction of invasive respiratory support accepted in the ED of the severe and critical patients, the AUCROC of the modified TEWS score were larger than both respectively (P<0.000,=0.001).7. The MEWS score, the TEWS score, the modified TEWS score were respectively positively correlated with the total hospitalization cost of the severe and critical patients (P=0.001,0.000,0.000), but not correlated with the total hospitalization duration of the severe and critical patients (P=0.996,0.439,0.407). The Spearman correlation coefficients were0.108,0.159,0.120between the total hospitalization cost and the MEWS score, the TEWS score, the modified TEWS score respectively.Conclusion1.Patients’age, gender, systolic blood pressure, respiratory rate, oxygen saturation, consciousness, mode of admission, whether with trauma, dyspnea, urinary dysfunction or pain help judge the prognosis of the severe and critical patients in ED.2. The TEWS score, age, dyspnea and urinary dysfunction are the independent risk factors which influence the severe and critical patients’ prognosis, so the modified TEWS score contains four variable parameters: TEWS score, age, dyspnea and urinary dysfunction.3. The modified TEWS score has higher worth than the MEWS score and the TEWS score on predicting the28d prognosis, being transferred to the ICU and the disposal accepted in the ED (CPR/electric defibrillation and invasive respiratory support) of the severe and critical patients.4. The TEWS score has higher worth than the MEWS score and the modified TEWS score on predicting being transferred to the general wards and operating room of the severe and critical patients.5. There is clinical significance for predicting hospitalization costs among the three warning scores, but the three warning scores in predicting the hospitalization duration are not practical.