Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database
Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database
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DOI：
10.1111/anae.12180
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发表时间：
2013-04-01
期刊：
影响因子：
10.7
通讯作者：
Johal, J.
中科院分区：
文献类型：
--
作者：
Carle, C.;Alexander, P.;Johal, J.
我们设计并在内部验证了一个针对产科人群的综合加权早期预警评分系统，该系统具有在病房环境中使用的潜力。从重症监护国家审计和研究中心的病例组合方案数据库中直接入院的产科患者随机分配到模型开发组(n=2240)或验证组(n=2200)。对危重病患者入院前24小时内收集的生理变量进行分析。模型开发集合中死亡率的Logistic回归分析最初用于创建基于统计的早期预警评分。然后对统计评分进行修改，以创建临床可接受的早期预警评分。这一产科临床预警评分的重要特征是，根据变量的统计重要性对变量进行加权，包含FiO2/PaO2关系的替代物，使用简化的警报/非警报变量评估意识水平，并且评分、触发阈值和响应与新的非产科国家预警评分系统一致。使用验证集对统计和临床早期预警分数进行内部验证。受试者工作特征曲线下面积为0.995(95%CI0.9920.998)，临床评分为0.957(95%CI0.9230.991)。先前存在的经验性设计的早期预警分数也以同样的方式进行了验证，以进行比较。Swanton等人的受试者操作特征曲线下面积为0.955(95%CI 0.9220.988)。S修改了产科早期预警系统，20032005年度英国孕产妇死亡保密调查报告中提出的产科早期预警评分为0.937(95%CI 0.8840.991)，非产科国家早期预警评分为0.973(95%CI 0.9570.989)。这突显了新的产科临床预警评分在区分这一重症监护数据集中的幸存者和非幸存者方面具有出色的能力。需要进一步的工作来验证我们在产科病房环境中的新的临床早期预警评分。
We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n=2240) or validation (n=2200) sets. Physiological variables collected during the first 24h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FIO2/PaO2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.9920.998) for the statistical score and 0.957 (95% CI 0.9230.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.9220.988) for Swanton etal.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.8840.991) for the obstetric early warning score suggested in the 20032005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.9570.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment.