摘要
目的比较评估AIS-ISS创伤评分和GCS评分对于颅脑外伤合并多发伤患者预后的判断价值。方法回顾性分析本院颅脑外伤合并多发伤患者的临床资料，分别记录AIS-Iss创伤评分和GCS评分，统计住院死亡病例，远期预后情况通过出院后随访1年时的GOS评分评定。采用Spearman检验分析两种评分与预后关系的相关系数，Kappa指数评估预测结果的一致性，绘制ROC曲线进行评分方法的敏感性和特异性比较。结果MS-ISS评分与颅脑外伤合并多发伤患者住院死亡和远期预后呈正相关，Spearman相关系数分别为0．434和0．469；GCS评分与住院死亡和远期预后呈负相关，Spearman相关系数分别为-0．410和-0．665。在预测住院死亡中，AIS-ISS评分和GCS评分的敏感性分别为66．07％和47．79％，特异性分别为71．24％和91．30％，一致率分别为69．82％和57．59％，Kappa值分别为0．330和0．243，ROC曲线下面积分别为0．756和0．740；在预测远期预后中，AIS-ISS评分和GCS评分的敏感性分别为91．22％和57．14％，特异性分别为67．52％和98．84％，一致率分别为71．60％和67．98％，Kappa值分别为0．371和0．402，ROC曲线下面积分别为0．773和0．879；上述差异均有统计学意义（P〈0．001）。结论在预测颅脑外伤合并多发伤患者的住院死亡和远期预后方面，AIS-ISS评分和GCS评分各具优势，互为补充。
Objective To compare the predictive value between AIS-ISS and GCS score for patients with traumatic brain injury combined multiple trauma. Methods The clinical data of patients suffering traumatic brain injury combined multiple trauma in our institution were analyzed retrospectively, of which AIS-ISS and GCS score were performed respectively. Cases of death in hospital were collected. GOS score was utilized to evaluate long-term prognosis of patients. Coefficients of above two scores to predict prognosis was analyzed by Spearman test. Consistency of results was evaluated by Kappa index. ROC curves were drawn to compare the sensitivity and specificity for the above two scores. Results Positive correlation between AIS-ISS score and prognosis involving death in hospital and long-term result for patients with traumatic brain injury combined multiple traumas was defined, and then spearman coefficients were 0.434 and 0.469 respectively. Negative correlation between GCS score and prognosis involving death in hospital and long-term result was defined, and then, spearman coefficients were -0.41 and -0.665 respectively. As for death in hospital, sensitivity, specificity, concordance rate, Kappa value, and area under ROC curve of AIS-ISS and GCS score were 66.07% and 47.79%, 71.24% and 91.30%, 69.82% and 57.59%, 0.330 and 0.243, 0.756 and 0.740 respectively. As for long-term result, sensitivity, specificity, concordance rate, Kappa value, and area under ROC curve of AIS-ISS and GCS score were 91.22% and 57.14%, 67.52% and 98.84%, 71.60% and 67.98%, 0,371 and 0.402, 0.773 and 0.879 respectively. Statistical significance was shown for above items （P 〈 0.001 ）. Conclusion AIS-ISS and GCS score have respective superiorities in the prediction of death in hospital and long-term prognosis for patients with traumatic brain injury combined multiple trauma, which can complement each other in clinical practice.
出处
《中国急救复苏与灾害医学杂志》
2013年第7期599-602,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
