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对比肺栓塞风险分层工具的预测性能,用于急性临床恶化
Anthony J Weekes1, Jaron D Raper1,2, Dasia Esener3
1Department of Emergency Medicine Atrium Health's Carolinas Medical Center Charlotte North Carolina USA.
概括
像ESC和PE-SCORE这样的肺栓塞风险评分比sPESI更好地预测短期临床恶化. 这些工具有助于识别需要更密切的诊断后监测的患者.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
背景情况:
- 现有的肺栓塞 (PE) 风险评分主要预测短期死亡率,而不是立即的不良事件.
- 准确的风险分层对于及时干预PE患者至关重要.
研究的目的:
- 评估三种PE风险分层工具的能力:简化肺栓塞严重程度指数 (sPESI),2019年欧洲心脏病学会 (ESC) 指南以及PE短期临床结果风险估计 (PE-SCORE).
- 预测PE的诊断在急诊室 (ED) 诊断后的5天临床恶化.
主要方法:
- 分析了六次ED的数据,其中包括已确认PE的患者.
- 临床恶化的定义是死亡,呼吸衰竭,心脏骤停,新的心律失常,持续的低血压或在5天内升级的干预.
- 确定sPESI,ESC和PE-SCORE在预测临床恶化的敏感性,特异性和预测值.
主要成果:
- 在1569名患者中,有24.5%的患者在5天内出现了临床恶化.
- 与sPESI (81.8%) 相比,ESC和PE-SCORE在预测恶化方面表现出更高的灵敏度 (98.7%和96.1%).
- 此外,ESC和PE-SCORE的负预测值也比sPESI (87.5%) 高 (97%和95.1%).
结论:
- 在确定PE诊断后有短期临床恶化风险的患者方面,ESC指南和PE-SCORE比sPESI更有效.
- 这些发现表明,ESC和PE-SCORE可以改善PE患者在ED环境中的早期风险分层.
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