| Objective: The emergency department is the first place where patients seek medical attention.Quick,accurate,safe and efficient triage in both primary medical institutions and superior hospitals is directly related to the treatment effect and prognosis of patients,and is of great significance to the reasonable allocation of medical resources,the improvement of medical staff’s work efficiency and even the guarantee of the operation and development of the emergency department.Timely monitoring of patients’ vital signs and other related indicators in the emergency room is to better understand the critical condition of patients,so as to make more reasonable triage.The National Early Warning Score is a tool for early standardized assessment of patients’ conditions,which can be used for early,rapid and accurate identification of potentially critical patients at risk of disease deterioration.Currently,it has been widely used in most emergency departments abroad.However,with the study of triage,it has been found that the shock index and its derivatives seem to be equally effective and accurate in assessing the patient’s condition and even prognosis.In this study,shock index and its derivative index were compared with NEWS score to study the application value of different shock indexes in the severity and prognosis evaluation of emergency patients.Methods: A retrospective analysis was conducted on 4240 patients who met the criteria admitted to the emergency department of the Affiliated Hospital of Hebei University from July 2019 to December 2019.Among which 2399 were male,female 1841 cases,30 days to prognosis for the study of the finish line,divided into survival group and death group,collect and record NEWS score in both groups,different shock index and prognosis,analysis of the two groups of patients with NEWS,scores and the differences between the shock index,Logistic regression analysis of the detection index and the relationship between short-term adverse outcomes for patients with critical patients.ROC curve was drawn to detect the ability of NEWS score and different shock indexes to judge short-term adverse prognosis.News score was used as the standard of disease severity,and Spearman correlation analysis was used to test the correlation between four shock indexes and NEWS score.Results: There was no significant difference in gender between the two groups(P > 0.05).Compared with the survival group,the national early warning score(NEWS score)of the death group was higher(P < 0.001).The shock index,modified shock index,body temperature-adjusted shock index and age shock index in the death group were significantly higher than those in the survival group[(1.198±0.583),(1.640±0.849),(1.170±0.571),(82.400±40.383)] Logistic regression analysis showed that NEWS 5-6 and NEWS≥7 were significantly positively correlated with death within 30 days,and the predicted death risk of patients within 30 days was 4.875 and 35.609 times that of patients with NEWS 0-4,respectively,P< 0.001.ROC curve analysis showed that shock index(AUC=0.828,95%CI=0.816-0.839),MSI(AUC=0.836,95%CI=0.825-0.847),ASI(T)(AUC=0.821,95%CI=0.809-0.832),Age SI(AUC=0.858,95%CI =0.848-0.869)and NEWS score(AUC=0.891,95%CI =0.881-0.900).The areas of four different shock indexes and NEWS score are all between 0.7-0.9,which have medium judgment ability in predicting the 30-day prognosis of critically ill patients.Yoden index indicates that patients with shock index≥0.9,MSI≥1.2,ASI(T)≥0.8,Age SI≥63.5 or NEWS score≥6.5 have poor prognosis,which has high sensitivity and specificity,and should be given corresponding nursing level and treatment measures to avoid the deterioration of patients’ condition.Conclusion: 1.The shock index(SI),modified shock index(MSI),Adjusted Shock Index corrected to temperature ASI(T)and age shock index(Age SI)can preliminary evaluation on the basis of measurements of vital signs the severity of the internal medicine in patients with critical patients of different ages,with the national early warning score(NEWS score)there is a positive correlation relationship,especially age shock index(Age SI),eliminate the effect of age on shock index,evaluation more accurate,is worth further discusses its application value in the emergency department.2.Four different shock index,required data simple,easy and convenient calculation to estimate the degree of critically ill patients with early triage,rapid screening out the "potential" critically ill patients with worsening risk,at the same time,can further evaluate national early warning score(NEWS score)as a supplement,screening patients with poor prognosis,corresponding treatment measures and nursing level.Any method of assessing the severity of a patient’s condition can only represent the condition of the patient in a certain period of time,while the disease is constantly developing and changing.In this dynamic process,evaluation,re-evaluation,decision making and re-decision are needed to avoid the occurrence of adverse events and reduce risks. |
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