Beyond Reporting Early Warning Score Sensitivity: The Temporal Relationship and Clinical Relevance of “True Positive” Alerts that Precede Critical Deterioration
Beyond Reporting Early Warning Score Sensitivity: The Temporal Relationship and Clinical Relevance of “True Positive” Alerts that Precede Critical Deterioration
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除了报告早期预警评分敏感性之外：严重恶化之前的“真阳性”警报的时间关系和临床相关性
DOI：
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发表时间：
2019
影响因子：
2.6
通讯作者：
Christopher P. Bonafide
中科院分区：
文献类型：
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作者：
M. Winter;Sherri Kubis;Christopher P. Bonafide
背景住院儿童的临床恶化很难发现。儿科Rothman指数（pRI）是一种早期预警评分，包括生命体征、实验室研究和护理评估，以产生恶化警报。(1)评估pRI警报的时间和临床医生在严重恶化事件（CDEs）之前识别恶化或升级护理的时间；(2)确定触发警报的参数在临床上是否与恶化相关。CDEs是指在转移后12小时内计划外转移至重症监护病房，并进行无创通气、气管插管和/或血管加压素输注。使用来自一家没有pRI的大型独立儿童医院的一年数据，我们分析了在pRI警报之前可能出现的cde。我们(1)将pRI警报的时间与描述患者状态变化和反映护理升级的医嘱的时间戳记录进行了比较；(2)确定了导致警报触发的评分成分，并确定这些成分是否与CDE病因临床相关。结果50个CDEs会触发pRI警报，如果pRI已经使用（灵敏度68%）。在90%的cde中，反映患者状态变化的第一个临床医生记录和/或反映护理升级的第一个医嘱先于第一个pRI警报。所有的生命体征和实验室指标及51%的护理指标均与CDE的病因有临床相关性。结论：有证据表明，在大多数在24小时内产生警报的CDEs中，临床医生在pRI警报之前就意识到病情恶化。
BACKGROUND Clinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts. OBJECTIVES (1) Evaluate the timing of pRI alerts and clinicians recognizing deterioration or escalating care prior to critical deterioration events (CDEs) and (2) determine whether the parameters triggering alerts were clinically related to deterioration. DESIGN CDEs are unplanned transfers to the intensive care unit with noninvasive ventilation, tracheal intubation, and/or vasopressor infusion in the 12 hours after transfer. Using one year of data from a large freestanding children’s hospital without the pRI, we analyzed CDEs that would have been preceded by pRI alerts. We (1) compared the timing of pRI alerts to time-stamped notes describing changes in patient status and orders reflecting escalations of care and (2) identified score component(s) that caused alerts to trigger and determined whether these were clinically related to CDE etiology. RESULTS Fifty CDEs would have triggered pRI alertsif the pRI had been in use (sensitivity 68%). In 90% of CDEs, the first clinician note reflecting change in patient status and/or the first order reflecting escalation of care preceded the first pRI alert. All of the vital sign and laboratory components of the pRI and 51% of the nursing components were clinically related to the etiology of the CDE. CONCLUSIONS Evidence that clinicians were awareof deterioration preceded pRI alerts in most CDEs that generated alerts in the preceding 24 hours.