Physiological-social score (PMEWS) vs. CURB-65 to triage pandemic influenza: a comparative validation study using community-acquired pneumonia as a proxy
Physiological-social score (PMEWS) vs. CURB-65 to triage pandemic influenza: a comparative validation study using community-acquired pneumonia as a proxy
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DOI：
10.1186/1472-6963-7-33
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发表时间：
2007-03-01
影响因子：
2.8
通讯作者：
Walter, Darren
中科院分区：
文献类型：
--
作者：
Challen, Kirsty;Bright, John;Walter, Darren
背景：流感大流行可能会使急诊科就诊人数增加7倍。在缺乏有效的“流感评分”来评估严重程度和帮助从初级保健到二级保健的分诊决定的情况下，目前英国的管理建议草案建议使用遏制-65和胸部X光作为替代。我们开发了大流行医学预警评分(PMEWS)来跟踪和分类流感患者，考虑了生理和社会因素，并且不需要实验室或放射学服务。方法：针对英国一家城市教学医院的社区获得性肺炎患者，对PMEWS评分进行验证。结果：PMEWS与STRET-65(AUROC分别为0.881和0.640)相比，PMEWS可以更好地预测入院需求(AUROC 0.944)和更高水平的护理需求(AUROC0.83)，但不能很好地预测后续住院死亡率(AUROC 0.663)。结论：PMEWS可以更好地预测住院需求(AUROC 0.944)和更高水平的护理需求(AUROC 0.83)，但不能很好地预测随后的住院死亡率(AUROC 0.663)。我们表明，PMEWS快速适用于将大量流感患者分流到自我护理、住院或HDU/ICU护理。它是可扩展的，以反映大流行期间将发生的入院门槛的变化。
Background: An influenza pandemic may increase Emergency Department attendance 7-fold. In the absence of a validated "flu score" to assess severity and assist triage decisions from primary into secondary care, current UK draft management recommendations have suggested the use of CURB-65 and chest X-ray as a proxy. We developed the Pandemic Medical Early Warning Score (PMEWS) to track and triage flu patients, taking into account physiological and social factors and without requiring laboratory or radiology services.Methods: Validation of the PMEWS score against an unselected group of patients presenting and admitted to an urban UK teaching hospital with community acquired pneumonia. Comparison of PMEWS performance against CURB-65 for three outcome measures: need for admission, admission to high dependency or intensive care, and inpatient mortality using area under ROC curve (AUROC) and the Hanley-McNeil method of comparison.Results: PMEWS was a better predictor of need for admission ( AUROC 0.944) and need of higher level of care ( AUROC 0.83) compared with CURB-65 (AUROCs 0.881 and 0.640 respectively) but was not as good a predictor of subsequent inpatient mortality ( AUROC 0.663).Conclusion: Although further validation against other disease datasets as a proxy for pandemic flu is required, we show that PMEWS is rapidly applicable for triage of large numbers of flu patients to self-care, hospital admission or HDU/ICU care. It is scalable to reflect changing admission thresholds that will occur during a pandemic.