Predicting Cardiac Arrest on the Wards A Nested Case-Control Study
Predicting Cardiac Arrest on the Wards A Nested Case-Control Study
复制标题
DOI：
10.1378/chest.11-1301
复制
发表时间：
2012-05-01
期刊：
影响因子：
9.6
通讯作者：
Edelson, Dana P.
中科院分区：
文献类型：
--
作者：
Churpek, Matthew M.;Yuen, Trevor C.;Edelson, Dana P.
背景资料：目前的快速反应小组激活标准没有统计学推导出病房的生命体征，心脏骤停（CA）的最佳生命体征预测尚未确定。此外，它是未知的，当生命体征开始，以准确地检测这一事件之前CA。方法：我们进行了巢式病例对照研究，88例患者经历CA的病房之间的大学医院2008年11月和2011年1月，匹配1：4到352名对照受试者居住在同一病房在同一时间的情况下CA。比较入院时和CA前48小时内的生命体征和改良早期预警评分（MEWS）。（64 ± 16岁vs 58 ± 18岁; P = .002），并且比对照组受试者更有可能既往入住ICU（41% vs 24%; P = 0.001），但入院MEWS相似（2.2 +/- 1.3 vs 2.0 +/- 1.3; P = 0.28）。在CA前48小时，最大MEWS是最好的预测因子（受试者工作特征曲线下面积[AUC] 0.77; 95% CI，0.71-0.82），然后是最大呼吸频率（AUC 0.72; 95% CI，0.65-0.78），最大心率（AUC 0.68; 95% CI，0.61-0.74）、最大脉压指数（AUC 0.61; 95% CI，0.54-0.68）和最小舒张压（AUC 0.60; 95% CI，0.53-0.67）。由48小时前CA，MEWS较高的情况下（P = .005），增加差距导致了事件。结论：MEWS是显着不同的患者经历CA和对照组患者之间的事件前48小时，但包括差的预测CA，如温度和省略显着的预测因子，如舒张压和脉压指数。胸部2012; 141（5）：1170-1176
Background: Current rapid response team activation criteria were not statistically derived using ward vital signs, and the best vital sign predictors of cardiac arrest (CA) have not been determined. In addition, it is unknown when vital signs begin to accurately detect this event prior to CA.Methods: We conducted a nested case-control study of 88 patients experiencing CA on the wards of a university hospital between November 2008 and January 2011, matched 1:4 to 352 control subjects residing on the same ward at the same time as the case CA. Vital signs and Modified Early Warning Scores (MEWS) were compared on admission and during the 48 h preceding CA.Results: Case patients were older (64 16 years vs 58 18 years; P = .002) and more likely to have had a prior ICU admission than control subjects (41% vs 24%; P = .001), but had similar admission MEWS (2.2 +/- 1.3 vs 2.0 +/- 1.3; P = .28). In the 48 h preceding CA, maximum MEWS was the best predictor (area under the receiver operating characteristic curve [AUC] 0.77; 95% CI, 0.71-0.82), followed by maximum respiratory rate (AUC 0.72; 95% CI, 0.65-0.78), maximum heart rate (AUC 0.68; 95% CI, 0.61-0.74), maximum pulse pressure index (AUC 0.61; 95% CI, 0.54-0.68), and minimum diastolic BP (AUC 0.60; 95% CI, 0.53-0.67). By 48 h prior to CA, the MEWS was higher in cases (P = .005), with increasing disparity leading up to the event.Conclusions: The MEWS was significantly different between patients experiencing CA and control patients by 48 h prior to the event, but includes poor predictors of CA such as temperature and omits significant predictors such as diastolic BP and pulse pressure index. CHEST 2012; 141(5):1170-1176