Construction And Implementation Of Early Warning Evaluation Scale For Postoperative Deterioration Of Patients With Hypertensive Intracerebral Hemorrhage

Objective:The objective of this study was to establish an early warning and evaluation tool for postoperative deterioration of Hypertensive intracerebral hemorrhage(HICH)patients suitable for neurosurgical nurses and to test its reliability,validity and prediction effect.It provides a scientific and objective basis for the effective observation of HICH patients’ postoperative conditions by nurses with low experience,and lays a research foundation for the implementation of dynamic early warning program of HICH patients’ postoperative deterioration.Methods:The study was divided into three parts.In the first part,the preliminary draft of early warning evaluation scale for postoperative deterioration of HICH patients was formed by case-control analysis method,and then the draft was revised by expert meeting method.The second part is to evaluate the clinical practicability and reliability of the early warning evaluation scale for postoperative deterioration of HICH patients.The third part tests the prediction effect of early warning rating scale of postoperative deterioration of HICH patients.Specific methods are as follows:1.Retrospective analysis was performed on 306 HICH patients who received craniotomy hematoma removal surgery from January 1,2016 to March 31,2021 in the Neurosurgery department of a Grade A General Hospital in Shanxi Province,to determine the risk factors for postoperative deterioration.2.The expert meeting method was adopted to select the experts in the clinical medical or nursing field of neurosurgery in Shanxi Province to grade and assign scores to the indicators in the initial draft,and finally form the early warning evaluation scale of postoperative deterioration of HICH patients based on the results of the case-control study and expert discussion.3.A total of 102 HICH patients admitted to the Neurosurgery Department of a Grade A general hospital in Shanxi Province from June 1,2021 to August 31,2021 were selected by convenience sampling method to evaluate the reliability and validity of the early warning rating scale for postoperative deterioration of HICH patients.4.A total of 83 HICH patients admitted to the Neurosurgery Department of a Grade A General hospital in Shanxi Province from September 1,2021 to January 31,2022 were selected as the study subjects by convenience sampling method,and receiver operating characteristic(ROC)curves were drawn.To compare the prediction effect of HICH early warning scale and modified early warning scale on the outcome of postoperative deterioration of patients.Results:1.In this study,8 early-warning indicators including respiratory rate,heart rate,body temperature,systolic blood pressure,intracranial pressure,blood oxygen saturation,pupil light reflex and related symptoms were preliminarily determined through case-control analysis.Nine experts from two grade A general hospitals in Shanxi Province were invited to attend the meeting,and the authority of the experts was 0.945.The reference intervals and corresponding scores of the five indicators of respiratory rate,heart rate,body temperature,systolic blood pressure and intracranial pressure were adjusted in the expert meeting,and the GCS scoring index was added.The final evaluation scale for early warning of postoperative deterioration of HICH patients included 9 items,and 0～3 points were assigned to the other indexes except body temperature,intracranial pressure,blood oxygen saturation and pupil light reflex,with a total score of 0～23 points.The risk degree of early warning rating scale was classified by quartile method: 0～3 was classified as low risk,4 ～ 8 was classified as medium risk,9～11 was classified as high risk,≥12was classified as extremely high risk.2.Reliability and validity test results showed that the Cronbach’s α coefficient of the early warning rating scale for postoperative deterioration of HICH patients was 0.723,the Cronbach’s α coefficient of each index was above 0.5,and the inter-rating reliability was 0.936.The content validity index(S-CVI)of the scale was 0.986,and the content validity index(I-CVI)of each item ranged from 0.875 to 1.000.Exploratory factor analysis extracted three common factors with characteristic values >1,and the cumulative variance contribution rate was 65.586%.The load value of each item in its common factor was greater than 0.4.All of them are in acceptable range with good reliability and validity.3.The area under ROC curve for MEWS to predict postoperative deterioration of patients was 0.722,the optimal cut-off value was 4.5 points,the sensitivity was 56.3%,the specificity was 83.6%,the Yorden index was 0.399,the positive predictive value was0.45,and the negative predictive value was 0.88.The area under ROC curve of the early warning rating scale for postoperative deterioration of HICH patients was 0.848,the optimal cut-off value was 4.5 points,the sensitivity was 81.3%,the specificity was77.6%,the Yuden index was 0.589,the positive predictive value was 0.46,and the negative predictive value was 0.95.Conclusion:Based on MEWS score,retrospective case study method and expert meeting method were used to develop a 9-item early warning evaluation scale for postoperative deterioration of HICH patients.The table has good reliability and validity,the items are simple,easy to understand,rapid and convenient evaluation,and strong operability.Than MEWS,HICH patients postoperative deterioration occurred postoperatively in patients with early warning assessment to predict progression of the higher sensitivity and specific degree,help neurosurgery nursing staff to identify patients with postoperative progression of the early warning signal,timely communication with the doctor patient condition,rescue in advance,so as to improve the successful rate and reduce the occurrence of serious adverse events.