Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward
Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward
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DOI：
10.1007/s00134-007-0532-3
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发表时间：
2007-04-01
影响因子：
38.9
通讯作者：
Harvey, Sheila
中科院分区：
文献类型：
--
作者：
Gao, Haiyan;McDonnell, Ann;Harvey, Sheila
目的：生理跟踪和触发警告系统 (TT) 用于识别重症监护区域外有病情恶化风险的患者，并向高级临床医生、重症监护外展服务或同等机构发出警报。这项工作的目的是： 描述已发布的文本以及每个文本根据既定程序开发的程度；审查关于现有系统的可靠性、有效性和实用性的已发表证据和可用数据；确定最佳 TT，以便及时识别危重患者。设计和设置：对通过电子、引文和手工检索以及专家信息提供者确定的研究进行系统审查。对英格兰和威尔士 31 家急症医院数据进行的队列研究。测量和结果：确定了 36 篇论文，描述了 25 个不同的文本。 31 篇论文描述了 TT 的使用，5 篇论文研究了 TT 的开发或测试。没有一项研究符合所有方法学质量标准。对于队列研究，结果是通过死亡、接受重症监护、“不要尝试复苏”或心肺复苏的综合来衡量的。十五个数据集符合预先定义的质量标准。敏感性和阳性预测值较低，中位数（四分位数）分别为 43.3 (25.4-69.2) 和 36.7 (29.3-43.8)。结论：使用的文本种类繁多，但可靠性、有效性和实用性的证据很少。灵敏度较差，部分原因可能是所监测的生理学性质或触发阈值的选择。现有数据不足以确定最佳 TT。
Objective: Physiological track and trigger warning systems (TTs) are used to identify patients outside critical care areas at risk of deterioration and to alert a senior clinician, Critical Care Outreach Service, or equivalent. The aims of this work were: to describe published TTs and the extent to which each has been developed according to established procedures; to review the published evidence and available data on the reliability, validity and utility of existing systems; and to identify the best TT for timely recognition of critically ill patients. Design and setting: Systematic review of studies identified from electronic, citation and hand searching, and expert informants. Cohort study of data from 31 acute hospitals in England and Wales. Measurements and results: Thirty-six papers were identified describing 25 distinct TTs. Thirty-one papers described the use of a TT, and five were studies examining the development or testing of TTs. None of the studies met all methodological quality standards. For the cohort study, outcome was measured by a composite of death, admission to critical care, 'do not attempt resuscitation' or cardiopulmonary resuscitation. Fifteen datasets met pre-defined quality criteria. Sensitivities and positive predictive values were low, with median (quartiles) of 43.3 (25.4-69.2) and 36.7 (29.3-43.8), respectively. Conclusion: A wide variety of TTs were in use, with little evidence of reliability, validity and utility. Sensitivity was poor, which might be due in part to the nature of the physiology monitored or to the choice of trigger threshold. Available data were insufficient to identify the best TT.