两种意识评估量表应用于神经外科患者中的信度和效度比较研究
Reliability and validity of the application of two consciousness assessment scales in neurosurgical patients
目的:比较和评价2种意识评估量表,全面无反应性量表(FOUR)和格拉斯哥昏迷量表(GCS)在神经外科患者中应用的信效度,为神经重症患者的意识评估提供有效的评估工具。方法选取南方医科大学南方医院神经外科患者100例,运用2种量表评估患者的意识,以Cronbachα系数、评估者间一致性信度、内容效度指数(CVI)以及受试者工作曲线(ROC)来判断预后预测的辨别力等方法评价和比较量表的信效度。同时收集同期血液的脑损伤程度的重要实验指标:S-100B蛋白和神经元特异性烯醇化酶(NSE)。结果 FOUR的Cronbachα为0.811, GCS的Cronbachα系数为0.923;评估者间一致性信度组内相关系数分别为0.972(FOUR)和0.979(GCS)。 CVI分别为0.965(FOUR)和0.973(GCS)。2种意识评估量表均对不良预后具有较好的辨别预测能力,ROC曲线下面积分别为0.938(FOUR)、0.932(GCS);预测不良预后的最佳分界值FOUR为12分、GCS为11分。 FOUR与NSE和S-100B蛋白的相关系数分别为-0.324(P<0.05)和-0.427(P<0.01);GCS与NSE和S-100B蛋白的相关系数分别为-0.316(P<0.05)和-0.395(P<0.01)。结论 GCS和FOUR都适合用于对神经外科患者意识评估,前者为神经外科医护人员所熟悉,而后者更适应评估气管切开或气管插管的患者且易于被神经外科医护人员记忆和掌握。
更多Objective To compared the reliability and validity of the application of two consciousness assessment scales in neurosurgical patients by Full Outline of Unresponsiveness Score Coma Scale (FOUR) and the Glasgow Coma Scale (GCS), and provide the effective evaluation for the consciousness of the nerve severe patients. Methods A total of 100 neurological intensive patients from Nanfang Hospital, Southern Medical University were enrolled and the consciousness was evaluated by FOUR and GCS. The reliability and validity of these scales were evaluated and compared by the following method such as Cronbach αcoefficient, the inter-rater agreement,content validity index (CVI) and the receiver operating characteristic curve (ROC) which used to predict the discrimination of prognosis.The important experimental indexes of blood of the degree of brain injury were collected in the same period:S-100 B protein and neuron specific enolization enzymes (NSE). Results The Cronbach α coefficient was 0.811 (FOUR) and 0.923(GCS). The overall rater agreement was excellent with an intraclass correlation coefficients of 0.972 (FOUR) and 0.979(GCS). CVI was 0.965 (FOUR) and 0.973 (GCS). Both scales had better distinguish and predictive abilities for the poor prognosis.The area under the curve for mortality was 0.938 for the FOUR and 0.932 for the GCS. The best cut-off values for predicting poor prognosis were FOUR of 12 and GCS of 11. For the FOUR, the correlation coefficient was-0.324(P<0.05) with the level of NSE,-0.427(P<0.01) with the level of S-100B protein. For the GCS,the correlation coefficient was-0.316 (P<0.05) with the level of NSE,-0.395 (P<0.01) with the level of S-100B protein. Conclusions Both FOUR and GCS are a reliable scale for evaluating the level of consciousness in neurosurgical patients. The GCS is familiar with the medical staff while the FOUR is more adapted to assess the patients with tracheotomy or intubated and which more easy to remember and learn by medical staff of neurosurgery department.
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