Prospective study on prediction of short-term risk of death by the establishment of emergency potential severity disease score

CHEN Fu-rong; ZHAO Wen-sui; XU Zhong-qing

doi:10.3969/j.issn.1002-1949.2014.04.011

Abstract：Objective To establish a new scoring method and explore its applicability in the identification of patients with emergency potential severity disease , through the amelioration of the modified early warning score ( MEWS ) .Methods Clinical profiles of 1235 patients presented at the emergency room were recorded and scored via MEWS and the new score method separately .Their next treatments and prognosis were followed up .The constituent ratios of death within 14 d, death after 14 d, length of stay more than 14 d, length of stay less than or equal to 14 d and outpatient treatment were compared among patients in different score ranges by MEWS and the new one; their ROC curves were compared in the evaluation and prediction on patients'prognosis; and the correlations between the two scoring methods and their correlation with the patients'prognosis were compared respectively .Results For those who scored 5 or above by MEWS , the constituent ratio of critically ill patients was significantly increased, compared to that of those who scored less than 5 ( P<0.05).For those who scored 5 or above by the new scoring method , the constituent ration of patients'length of stay more than 14 d was significantly increased ( P <0.05 ); above 10, the constituent ratio of critically ill patients was significantly increased ( P <0.05 ); above 15, constituent ration of patients'death within 14 d was significantly increased (P<0.05).For the identification ability of the evaluation and prediction on the risk of death within a short term , the new scoring method had a bigger proportion under the ROC curve than that of the MEWS scoring (P<0.001).The new scoring method was more correlative than MEWS scoring with the prognosis (P<0.05), and the more severe the prognosis was , the larger the score by the new method would be .Conclusion Both the MEWS and the new scoring method can be used in evaluating the severity of emergency patients'illnesses, which could help to identify some emergency potential severity disease .The new scoring method functions better in judging the length of stay and short-term risk of death for the emergency patient with only an additional blood routine examination , whose rapidness, low expense and convenience is comparable to MEWS .Therefore, the new scoring method is more suitable for the domestic emergency department .