目的·采用改良版TriAGe+评分预测急诊室急性前庭综合征（acute vestibular syndrome，AVS）患者发生脑梗死（cerebral infarction，CI）的可能性，评估改良版TriAGe+评分的临床应用价值。方法·收集2021年1月1日—2021年8月31日于上海交通大学医学院附属第九人民医院神经内科急诊就诊的AVS患者255例，其中CI患者128例，周围性眩晕患者127例。采用t检验或Mann-Whitney U检验对定量数据进行组间比较，采用χ2检验对定性资料进行组间比较。绘制受试者操作特征曲线（receiver operating characteristic curve，ROC curve，ROC曲线）比较TriAGe+评分、ABCD²（age, blood pressure, clinical features, duration of symptoms and diabetes）评分、后循环缺血（posterior circulation ischemia，PCI）评分对AVS患者发生CI的预测效果，并计算曲线下面积（area under curve，AUC）。采用多因素Logistic回归研究各种实验室指标对CI的预测作用。之后将TriAGe+评分与预测CI独立相关的实验室检查相结合形成改良版TriAGe+评分，并评价该评分预测效果。结果·在2组变量中，脑梗死组男性、高血压、房颤史、无头晕或前庭迷路病史、有头晕症状较周围性眩晕组所占比例高，且差异有统计学意义（均P <0.05）。与ABCD²评分、PCI评分相比，TriAGe+评分AUC最大（0.859，95%CI 0.814~0.904），差异有统计学意义（P=0.000）。多因素Logistic回归结果显示血糖值（P=0.007）和血尿酸值（P=0.008）是预测CI的独立危险因素。当血糖值>7.95 mmol/L显示最佳的AUC，灵敏度为61.7%，特异度为66.1%；当血尿酸值>382.5 μmol/L显示最佳AUC，灵敏度为35.2%，特异度为85.0%。当血尿酸值>382.5 μmol/L为1分，当血糖值>7.95 mmol/L为1分，将其加入TriAGe+评分形成改良版TriAGe+评分，其诊断效果（AUC=0.872，95%CI 0.828~0.915）优于TriAGe+评分（P=0.007）。当改良版TriAGe+评分临界值为10.5时，其诊断准确性最佳，灵敏度为81.3%、特异度为80.3%。结论·改良版TriAGe+评分在识别AVS中CI患者的发生方面具有很好的临床应用价值。

Objective ·To predict the likelihood of cerebral infarction (CI) in emergency department patients with acute vestibular syndrome (AVS), and to evaluate the clinical value of modified TriAGe+ score. Method ·Patients with AVS admitted to the Emergency Department of Neurology of Shanghai Ninth People's Hospital from January 1, 2021 to August 31, 2021 were collected. There were 128 cases of CI and 127 cases of peripheral vertigo. t test or Mann-Whitney U test was used for inter-group comparison of quantitative data, and χ2 test was used for inter-group comparison of qualitative data. Receiver operating characteristic curve (ROC curve) and area under the curve (AUC) were used to compare the prediction effect of TriAGe+ score, age, blood pressure, clinical features, duration of symptoms and diabetes score (ABCD² score) and posterior circulation ischemia (PCI) score for CI in patients with AVS. Logistic regression was used to study the influence of laboratory indicators on prediction of CI. The TriAGe+ score was then combined with laboratory indicators to formulate improved TriAGe+ score. Results ·In the two groups of variables, the proportion of male, hypertension, history of atrial fibrillation, no history of dizziness or vestibular labyrinth, and dizziness symptom in CI group was higher than that in peripheral vertigo group, and the difference was statistically significant (all P<0.05). Compared with ABCD² score and PCI score, TriAGe+ score had the highest AUC (0.859, 95%CI 0.814?0.904), which was statistically significant (P=0.000). Multivariate Logistic regression results showed that blood glucose level (P=0.007) and blood uric acid level (P=0.008) were independent risk factors for predicting CI. When blood glucose level was greater than 7.95 mmol/L, the best AUC showed a sensitivity of 61.7% and specificity of 66.1%. At the same time, serum uric acid value greater than 382.5 μmol/L showed the best AUC with sensitivity of 35.2% and specificity of 85.0%. When the blood uric acid value is greater than 382.5 μmol/L, it is one point, and when the blood glucose value is greater than 7.95 mmol/L, it is one point, which is added to the TriAGe+ score to form the modified TriAGe+ score. The diagnostic value of the modified TriAGe+ score (AUC=0.872, 95%CI 0.828?0.915) was larger than TriAGe+ score (P=0.007). When the critical value of modified TriAGe+ score was 10.5, the diagnostic accuracy was the best, when the sensitivity was 81.3%, and the specificity was 80.3%. Conclusion ·The modified TriAGe+ score has better clinical application in identifying the occurrence of stroke in patients with acute vestibular syndrome.