Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit: A validation study of six existing scores
Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit: A validation study of six existing scores
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DOI：
10.1016/j.ejim.2017.09.042
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发表时间：
2017-11-01
影响因子：
8
通讯作者：
Posth, Stefan
中科院分区：
文献类型：
--
作者：
Brabrand, Mikkel;Hallas, Peter;Posth, Stefan
引言：“预警评分”（EWS）已被开发出来，以量化生命体征异常的水平。然而，许多分数尚未得到验证。本研究的目的是验证六个分数，都依赖于生命体征：快速急性生理评分（RAPS），快速急诊医学评分（REMS）和国家早期预警评分（NEWS）和Goodacre，Groarke和Worthing生理scores.Methods：前瞻性收集的生命体征急性入院的医疗患者到丹麦医院的事后单中心观察性队列研究。所有到达一家拥有450张床位的地区教学医院的急性医疗单位的成年患者都包括在内。到达后，我们记录了初始生命体征，仅包括研究期间的首次就诊。患者入组时间为2012年6月1日至10月31日。全因24小时死亡率和总住院死亡率作为终点。高于0.8的判别力被认为是acceptable.Results：5784例患者，中位年龄为67（49-78）岁，32例（0.6%）在24小时内死亡，161例（2.8%），而入院。所有评分（Groarke评分（0.587）除外）的24 h死亡率判别力均高于0.8，Worthing评分的判别力最高（0.847）。预测整体住院死亡率的判别能力是最高的Goodacre和沃辛评分（分别为0.810和0.800），但低于0.8的其余scores.Conclusion：Goodacre评分和沃辛生理评分有很好的判别能力，在确定患者的24小时和住院死亡率的风险增加，在我们的设置。(C)2017年欧洲内科联盟。Elsevier B. V.出版，保留所有权利。
Introduction: "Early warning scores" (EWS) have been developed to quantify levels of vital sign abnormality. However, many scores have not been validated. The aim of this study was to validate six scores that all rely on vital signs: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS) and the Goodacre, Groarke and Worthing physiological scores.Methods: A posthoc single-center observational cohort study of prospectively collected vital signs on acutely admitted medical patients to a Danish hospital. All adult patients arriving at an acute medical unit at a 450-bed regional teaching hospital were included. Upon arrival, we registered initial vital signs and only the first presentation in the study period was included. Patients were included from 1 June to 31 October 2012. All-cause 24-h mortality and overall in-hospital mortality were used as endpoints. A discriminatory power above 0.8 was considered acceptable.Results: 5784 patients were included with a median age of 67 (49-78) years, 32 (0.6%) died within 24 h and 161 (2.8%) while admitted. Discriminatory power for 24 h mortality was above 0.8 for all scores (except the Groarke score (0.587)) and highest for the Worthing score (0.847). The discriminatory power for predicting overall in-hospital mortality was highest for the Goodacre and Worthing scores (0.810 and 0.800 respectively) but below 0.8 for the remaining scores.Conclusion: The Goodacre score and the Worthing physiological score have good discriminatory power at identifying patients at increased risk of 24-h and in-hospital mortality in our setting. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.