Measuring the Modified Early Warning Score and the Rothman Index: Advantages of Utilizing the Electronic Medical Record in an Early Warning System
Measuring the Modified Early Warning Score and the Rothman Index: Advantages of Utilizing the Electronic Medical Record in an Early Warning System
复制标题
DOI：
10.1002/jhm.2132
复制
发表时间：
2014-02-01
影响因子：
2.6
通讯作者：
Smith, Robert A.
中科院分区：
文献类型：
--
作者：
Finlay, G. Duncan;Rothman, Michael J.;Smith, Robert A.
及早发现即将发生的心脏或肺骤停是医院努力提高护理质量的一个重要重点。不幸的是，当前所有预警系统的误报率都很高。大多数系统都基于修正早期预警评分 (MEWS)；其 5 个输入中有 4 个是生命体征。本研究的目的是比较 MEWS 与 Rothman Index (RI) 的准确性，Rothman Index (RI) 是一种基于利用电子病历 (EMR) 中的附加数据的超额风险函数求和的患者敏锐度评分。对 32,472 名就诊患者进行回顾性计算 MEWS 和 RI 评分。护理评估是 RI 使用的 EMR 输入类别，在死亡前 24 小时显示出巨大差异。 24 小时死亡率的接受者操作特征曲线显示出卓越的 RI 性能，c 统计量分别为 0.82 和 0.93。在MEWS触发警报的点上，我们确定了同等灵敏度对应的RI点，发现MEWS的阳性似然比（LR+）为7.8，RI为16.9，误报减少了53%。在对应于相等 LR+ 的 RI 点，MEWS 的敏感性为 49%，RI 的敏感性为 77%，捕获的 24 小时内死亡的患者多出 54%。医院医学杂志 2014 年；9：116-119。 2013 年作者。 《医院医学杂志》由 Wiley periodicals, Inc. 代表医院医学协会出版
Early detection of an impending cardiac or pulmonary arrest is an important focus for hospitals trying to improve quality of care. Unfortunately, all current early warning systems suffer from high false-alarm rates. Most systems are based on the Modified Early Warning Score (MEWS); 4 of its 5 inputs are vital signs. The purpose of this study was to compare the accuracy of MEWS against the Rothman Index (RI), a patient acuity score based upon summation of excess risk functions that utilize additional data from the electronic medical record (EMR). MEWS and RI scores were computed retrospectively for 32,472 patient visits. Nursing assessments, a category of EMR inputs only used by the RI, showed sharp differences 24 hours before death. Receiver operating characteristic curves for 24-hour mortality demonstrated superior RI performance with c-statistics, 0.82 and 0.93, respectively. At the point where MEWS triggers an alarm, we identified the RI point corresponding to equal sensitivity and found the positive likelihood ratio (LR+) for MEWS was 7.8, and for the RI was 16.9 with false alarms reduced by 53%. At the RI point corresponding to equal LR+, the sensitivity for MEWS was 49% and 77% for RI, capturing 54% more of those patients who will die within 24 hours. Journal of Hospital Medicine 2014;9:116-119. 2013 The Authors. Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine