Prognosis and Risk Factors for Deterioration in Patients Admitted to a Medical Emergency Department
Prognosis and Risk Factors for Deterioration in Patients Admitted to a Medical Emergency Department
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DOI：
10.1371/journal.pone.0094649
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发表时间：
2014-04-09
期刊：
影响因子：
3.7
通讯作者：
Lassen, Annmarie Touborg
中科院分区：
文献类型：
--
作者：
Henriksen, Daniel Pilsgaard;Brabrand, Mikkel;Lassen, Annmarie Touborg
目的：到达医院时最初表现稳定的患者通常对其生命体征的监测不太密集，可能导致死亡率过高。其目的是描述危险因素的生命体征恶化和相关的预后与正常的生命体征患者在抵达医疗急诊科（MED）。设计和设置：单中心，回顾性队列研究的所有患者入院MED从2010年9月至2011年8月。主题：当患者到达时其生命体征（收缩压、脉率、呼吸频率、格拉斯哥昏迷量表、氧饱和度和体温）在正常范围内时，将其纳入研究。恶化定义为到达后2-24小时偏离定义的正常范围。6257中的4292（68.6%）的MED患者在首次就诊时具有全套生命体征，1440/4292 33.6%的患者生命体征正常，44.0%为男性，中位年龄64岁（第5/95百分位数：21-90岁）和446/1440（31.0%）在24小时内恶化。恶化的独立危险因素包括年龄65-84岁比值比（OR）：1.79（95%置信区间[CI]：1.27-2.52），85岁以上或1.67（95% CI：1.10-2.55），不需紧急复苏顺序OR 3.76（95% CI：1.37-10.31）和从开放性普通艾德入院OR 1.35（95% CI：1.07-1.71）。30天死亡率为7.9%（95% CI：5.5-10.7%），（95% CI：1.2-3.0%），风险比为4.11（95% CI：2.38-7.10）。在入院时生命体征正常的急性住院患者中，31.0%在24小时内出现恶化迹象。危险因素包括高龄、不需抢救令、开放性普通急诊室入院。恶化患者的30天死亡率是非恶化患者的4倍。需要进一步的研究来确定是否加强对生命体征的监测可以帮助预防医疗急诊患者的恶化或死亡。
Objective: Patients that initially appear stable on arrival to the hospital often have less intensive monitoring of their vital signs, possibly leading to excess mortality. The aim was to describe risk factors for deterioration in vital signs and the related prognosis among patients with normal vital signs at arrival to a medical emergency department (MED).Design and setting: Single-centre, retrospective cohort study of all patients admitted to the MED from September 2010-August 2011. Subjects: Patients were included when their vital signs (systolic blood pressure, pulse rate, respiratory rate, Glasgow Coma Scale, oxygen saturation and temperature) were within the normal range at arrival. Deterioration was defined as a deviation from the defined normal range 2-24 hours after arrival.Results: 4292 of the 6257 (68.6%) admitted to the MED had a full set of vital signs at first presentation, 1440/4292 (33.6%) had all normal vital signs and were included in study, 44.0% were male, median age 64 years (5th/95th percentile: 21-90 years) and 446/1440 (31.0%) deteriorated within 24 hours. Independent risk factors for deterioration included age 65-84 years odds ratio (OR): 1.79 (95% confidence interval [CI]: 1.27-2.52), 85+ years OR 1.67 (95% CI: 1.10-2.55), Do-not-attempt-to-resuscitate order OR 3.76 (95% CI: 1.37-10.31) and admission from the open general ED OR 1.35 (95% CI: 1.07-1.71). Thirty-day mortality was 7.9% (95% CI: 5.5-10.7%) among deteriorating patients and 1.9% (95% CI: 1.2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10).Conclusions: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open general ED. Thirty-day mortality among patients with deterioration was four times higher than among non-deteriorating patients. Further research is needed to determine whether intensified monitoring of vital signs can help to prevent deterioration or mortality among medical emergency patients.