Construction Of Early Warning Score Of Urinary Tract Infection In The Patients With Stroke

Objective:1.Meta analysis was used to identify risk factors for stroke associated urinary tract infections.2.Based on the meta analysis results,an expert team was organized to to establish an early warning score for stroke associated urinary tract infections.3.The case data was collected to verify the constructed warning scale.Methods:1.A computer-based search for cohorts and case-control studies of stroke associated urinary tract infections at China and abroad was conducted.Two investigators independentlyperformedliteraturescreeningsanddataextractions.The Newcastle-Ottawa Scale was used to evaluate the quality of the literature,the score of 6stars or more was included in the study.Rev Man 5.2 software was used for heterogeneity test(test level?=0.1),sensitivity analysis,and publication bias test.Count data used odds ratio(OR)as the effect index.2.Initially included risk factors that were statistically significant by meta analysis,and targeted sampling expert from neurology,neurosurgery,intensive medicine,and hospital flu staff in a tertiary general hospital.Add,stratified and classified the items,discussed the instructions and assignment about options.According to the meta analysis,OR values are assigned to risk factors.1.2?OR<1.5 is a weak correlation(1 point),and1.5?OR<3 is a moderate correlation(2 points),3?OR<10 is a strong association(3points)to establish an early warning score sheet.3.Retrospective analysis of hospitalized patients with stroke in a tertiary general hospital in December 2017,statistics of the actual occurrence of urinary tract infections and early warning scores in each patient,and verification of the predictive effect of the score sheet.Data was recorded and statistically analyzed using Epidata 3.1 and SPSS16.0.Because the the warning scores of non-infected group did not obey the normal distribution,the two components were compared using the Mann-Whitney U test.The test level was?=0.05.The ROC curve was plotted,and the predictive power was evaluated by the area under the ROC curve.The maximum value of the youden index was taken as the best cutoff value,and the sensitivity,specificity,positive likelihood ratio,and negative likelihood ratio were analyzed.According to the cut-off value,patients were divided into high-risk group and low-risk group,the difference between the incidence of urinary tract infection was compared by?~2 test,test level?=0.05.Results:1.Meta analysis included a total of 23 articles,analyzed 16 factors,the results showed:"difficulty urination","indwelling catheter","hyperproteinemia","age?60years"a total of 4 risk factors had strong correlation with urinary tract infections;"hemorrhagic stroke,""impaired consciousness,""atrial fibrillation,""female,"and"diabetes"a total of 5 had moderate correlation;"history of stroke"had weak correlation.There wereno statistically significant differences in"hemilateral lesions","hyperlipidemia","hypertension","heart failure","COPD"and"smoking history"(P>0.05).2.Eleven specialists in clinical medicine,nursing,epidemiology and health statistics participated in the group discussion and their titles were intermediate and above.Bring into the factor of"urinary incontinence",the"impaired consciousness"was divided into two levels according to the degree,the"indwelling catheter"was divided into two levels according to the retention time,and the risk factors related to voiding were classified.The resulting early warning score sheet includes 9 items,and the specific contents and scoring results including stroke type hemorrhage=2,female=2,"age?60years old"=3,diabetes=2,atrial fibrillations=2,hypoproteinemia=3,history of stroke=1,consciousness(somnolence-stupor=1;coma=2),urination(urinary incontinence=2;dysuria=3;"indwelling catheter<7 days"=2;"indwelling catheter?7 days"=3).3.A total of 171 cases were analyzed retrospectively.There was a statistically significant difference in the pre-alarm score between the infected group(18 cases)and the non-infected group(153 cases)(P<0.001).The area under the ROC curve was 0.821and the cut-off value was 7.5.0.611 was the largest youden index,the sensitivity and specificity were 83.3%and 77.8%,and the positive and negative likelihood ratios were3.75 and 0.21.The score scale has a total score of 20 points,of which 0-7 is divided into low-risk group,8-20 is divided into high-risk group,and the difference of actual urinary tract infection rate between low-risk group and high-risk group was statistically significant(P<0.001).Conclusion:1."Difficulty urinating","indwelling catheter","hyperproteinemia","age?60 years old","hemorrhagic stroke","disorder of consciousness","atrial fibrillation","Women","diabetes",and"history of stroke"were risk factors for stroke associated urinary tract infections.2.The construction of early warning scale for stroke associated urinary tract infections was based on meta analysis and expert opinion.It was scientific and practical,and had proven ability to predict.It can provide some reference for early screening of high-risk patients and the establishment of nursing strategies.