Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care - A pilot study in a tertiary-care hospital
Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care - A pilot study in a tertiary-care hospital
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DOI：
10.5694/j.1326-5377.1999.tb123492.x
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发表时间：
1999-07-05
影响因子：
11.4
通讯作者：
Anderson, J
中科院分区：
文献类型：
--
作者：
Buist, MD;Jarmolowski, E;Anderson, J
目的：探讨危重事件(心脏骤停或非计划入院重症监护)前住院患者临床不稳定因素的性质和持续时间。设计：对所有危重事件(CES)超过12个月的患者的病历进行回顾性调查。收集住院患者和重症监护病房(ICU)患者的数据，并与研究人群进行比较。地点：一所有300张床位的大都市教学医院，ICU有7张床位。患者：所有患者在12个月期间(1997年1月至12月)进行CES。主要观察指标：CE1前临床不稳定患者的数量；CE1前临床不稳定的持续时间；每个患者在CE前的医学复查次数；所有患者的死亡率和住院时间。结果：112例患者中122例CEs(中位数1；范围1~4)。在CES中，79人是计划外ICU入院(14人在心脏骤停电话之后)，43人是心脏骤停电话而不是ICU入院。每个CE之前都有两个(范围0-9)临床不稳定标准的中位数。CE前不稳定持续时间的中位数为6.5小时(范围为0-432小时)，在此期间进行了两次中位数(范围为0-13次)的医学审查。CES在住院总人数(122例CES/19853例)和ICU患者(79例计划外住院患者/515例)中的发生率分别为0.6%和15%。112例患者中死亡70例(62%)，住院死亡392例(2%)，其中ICU死亡107例。然而，那些经常在行政长官面前的简单物理观察和实验室测试结果中表现出异常的人。对警示信号进行更迅速的干预可能会为这些患者提供更好的结果。
Objective: To investigate the nature and duration of clinical instability tie, abnormalities in simple physical observations or laboratory test results) in hospital patients before a "critical event" (ie, a cardiac arrest or an unplanned admission to intensive care).Design: Retrospective survey of medical records of all patients having critical events (CEs) over 12 months. Data on hospital and Intensive Care Unit (ICU) patients were obtained for comparison with the study population.Setting: A 300-bed metropolitan teaching hospital with a seven-bed ICU.Patients: All patients having CEs over a 12-month period (January to December 1997).Main outcome measures: Number of patients with clinical instability before a CE; duration of clinical instability before a CE; number of medical reviews of each patient before a CE; mortality rate and length of hospital stay for all patients.Results: There were 122 CEs in 112 patients (median, 1; range, 1-4). Of the CEs, 79 were unplanned ICU admissions (14 subsequent to cardiac arrest calls), and 43 were cardiac arrest calls not resulting in ICU admission. Each CE was preceded by a median of two (range, 0-9) criteria for clinical instability. The median duration of instability before a CE was 6.5 hours (range, 0-432 hours), and in that time a median of two (range, 0-13) medical reviews took place. The incidence of CEs in the total hospital population (122 CEs/19 853 admissions) and in ICU patients (79 unplanned admissions/515 admissions) was 0.6% and 15%, respectively. There were 70 deaths (62%) among the 112 patients, compared with a total of 392 deaths (2% of admissions) in the hospital, of which 107 were in ICU.Conclusions: Very few patients suffer a CE while in hospital. However, those who do frequently manifest abnormalities in simple physical observations and laboratory test results before the CE. More rapid intervention in response to warning signs might provide a better outcome for these patients.