Construction Of Early Warning Score For Critical Patients In Neurosurgery And Its Predictive Effect

ObjectivesBased on the scores of acute physiology and chronic health evaluation II(APACHE II),we explored the specific indicators related to the early warning of critical ill patients in neurosurgery,constructed the early warning score for critical ill patients in neurosurgery,and objective to explore the predictive value of early warning score of neurosurgery critical ill patients in the prognosis of critical ill patients in neurosurgery.Methods1.Literature research: Searching domestic and foreign databases,exploring related indicators for early warning of critical patients in neurosurgery,combined with APACHE II score,to provide a reference for constructing early warning score of critical patients in neurosurgery.2.Delphi method: Two rounds of expert correspondence were conducted with 28 experts from neurosurgery critical care,nursing and other related research fields,and finally the early warning score of neurosurgery critical patients was established.3.Reliability and validity test of early warning score for critical patients in neurosurgery: From January to June in 2018,160 neurosurgery critical patients hospitalized in neurosurgery intensive care unit of a tertiary hospital in Qingdao were selected as the research objects by convenience sampling method,and they were scored by early warning score of critical patients in neurosurgery.Cronbach’s α coefficient,content validity and structural validity were used to evaluate the reliability and validity of early warning score of critical patients in neurosurgery.4.The predictive effect of early warning score for critical patients in neurosurgery.on the prognosis of patients: From July 2018 to July 2019,268 neurosurgery critical patients in neurosurgery intensive care unit of a tertiary hospital in Qingdao were selected as the research objects.The outcome of patients transferred out of neurosurgical intensive care unit was recorded.The early warning score of neurosurgery critical patients and the national early warning score(NEWS)were used to evaluate the accuracy of the two scores in predicting the prognosis of critical patients in neurosurgery.Results1.After two rounds of consultation by 28 experts,the early warning score of critically ill patients in neurosurgery department was finally determined,including three primary indicators and eight secondary indicators of vital signs,percutaneous blood gas analysis and neurological function.2.The Cronbach’s α coefficient of the early warning score in critical neurosurgical patients was 0.92,and the Cronbach’s α coefficients of vital signs,percutaneous blood gas analysis,and neurological function in the first-level indicators were 0.92,0.91,and 0.92,respectively;The scale-level content validity index,(S-CVI)was 0.95,and the item-level content validity index(I-CVI)was between 0.82 and 1.000.Kmo(Kaiser Meyer Olkin)was 0.74,and Bartlett’s test of sphericity was 80.44(P<0.01).Two common factors(eigenvalue > 1)were extracted by principal component analysis,and the overall explained variance was 63.76%.3.The observation point was transferred out of the neurosurgical intensive care unit,the area under ROC curve of the early warning score in critical neurosurgical patients was0.93,the best cut-off value was 6.5,the sensitivity was 0.97,and the specificity was 0.79;The area under ROC curve of news was 0.80,the best cut-off value was 8.5,the sensitivity was 0.80,and the specificity was 0.79.There was significant difference between the area under the ROC curve of the two scores(z = 6.26,P<0.01).Conclusions1.Based on the APACHE II score,the early warning score of critical patients in neurosurgery constructed through expert correspondence had good reliability and validity,which made up for the lack of early warning score for specialty critical patients.2.Early warning score of critical patients in neurosurgery has a high predictive value for the prognosis of neurosurgery critical patients.It is more professional,practical,sensitive,and is more suitable for rapid medical environment,and is worthy of clinical promotion.