摘要
目的系统评价改良早期预警评分(MEWS)在急诊预检分诊中识别潜在危重症患者的能力。方法系统检索PubMed、the Cochrance Library、EMbase、Web of Science核心合集数据库、中国生物医学文献数据库、维普网、万方数据知识服务平台、中国知网等数据库,搜集MEWS在急诊分诊中的应用效果相关文献,提取资料并进行meta分析。检索时间为建库至2024年5月。由两名研究者独立完成文献筛选和数据提取工作。采用双变量随机效应模型合并MEWS识别潜在危重症患者的分诊效果的灵敏度、特异度和诊断比值比(DOR);合并灵敏度和特异度用于构建合并受试者操作特征(SROC)曲线,曲线下面积用于评价MEWS的分诊效果;采用Deek漏斗图评价文献发表偏倚;采用范根图评价MEWS的临床适用性。结果共纳入15项研究。meta分析结果显示,MEWS合并灵敏度为0.72(95%CI:0.56~0.84),P=0.00;合并特异度为0.94(95%CI:0.87~0.97),P=0.00;合并DOR为39.39(95%CI:12.41~124.99),P=0.00;阳性似然比为11.65(95%CI:5.20~26.11),P=0.00;阴性似然比为0.30(95%CI:0.18~0.50),P=0.00。MEWS的SROC曲线下面积为0.92(95%CI:0.90~0.94)。亚组分析结果显示,患者类型,结局指标和病例选择偏倚风险可能是异质性来源。范根图分析显示,MEWS评估阳性时,受试者诊断为危重症的概率上升。结论MEWS的临床适用性较好,但在识别急诊潜在危重症患者诊断效能有一定的不足。
Objective To systematically evaluate the ability of the modified early warning score(MEWS)to identify potentially critically ill patients in emergency pre-examination and triage.Methods Databases such as PubMed,the Cochrance Library,EMbase,Web of Science Core Collection Database,China Biomedical Literature Database,VIP Network,Wanfang Data Knowledge Service Platform,and China National Knowledge Infrastructure have been systematically retrieved.The relevant literature on the application effect of MEWS in emergency triage,extract the data and conduct a meta-analysis were collect.The search period is from the establishment of the database to May 2024.The literature screening and data extraction were independently completed by two researchers.The sensitivity,specificity and diagnostic odds ratio(DOR)of the triage effect in identifying potentially critically ill patients using the bivariate random effects model combined with MEWS.The combined sensitivity and specificity were used to construct the summary receiver operating characteristic(SROC)curve,and the area under the SROC curve was used to evaluate the triage effect of MEWS.The Deek funnel plot was used to evaluate the publication bias of the literature.The clinical applicability of MEWS was evaluated by using the Fan Gen Chart.Results A total of 15 studies were included in the meta-analysis.The pooled sensitivity of MEWS was 0.72(95%CI:0.56-0.84),P=0.00;the pooled specificity was 0.94(95%CI:0.87-0.97),P=0.00.The combined DOR was 39.39,(95%CI:12.41-124.99),P=0.00.The positive likelihood ratio was 11.65(95%CI:5.20-26.11),P=0.00;the negative likelihood ratio was 0.30(95%CI:0.18-0.50),P=0.00.The area under the SROC curve of the MEWS was 0.92(95%CI:0.90、0.94).Subgroup analysis showes that patient types,outcome measures and risk of flow and timing bias may be sources of heterogeneity.Fan Gen Chart analysis showed that when the MEWS assessment was positive,the probability of the subjects being diagnosed with critical illness increased.Conclusion The clinical applicability of MEWS is relatively good,but there are certain deficiencies in its diagnostic efficacy in identifying potentially critically ill patients in the emergency department.
作者
王嘉颖
史冬雷
徐军
孙朋霞
李凡
刘晓颖
WANG Jiaying;SHI Donglei;XU Jun;SUN Pengxia;LI Fan;LIU Xiaoying(School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Department of Nursing,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中国医药导报》
2025年第14期189-196,共8页
China Medical Herald
关键词
改良早期预警评分
急诊科
预检分诊
META分析
Modified early warning score
Emergency department
Pre-examination triage
Meta-analysis
