Derivation of a cardiac arrest prediction model using ward vital signs
Derivation of a cardiac arrest prediction model using ward vital signs
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DOI：
10.1097/ccm.0b013e318250aa5a
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发表时间：
2012-07-01
影响因子：
8.8
通讯作者：
Edelson, Dana P.
中科院分区：
文献类型：
--
作者：
Churpek, Matthew M.;Yuen, Trevor C.;Edelson, Dana P.
目的：使用专家意见创建快速反应小组激活标准，并在先前的研究中证明了可变的准确性。我们开发了一种心脏骤停风险分诊评分来预测心脏骤停，并将其与改良早期预警评分（一种常被引用的快速反应团队激活标准）进行比较。设计：一项回顾性队列研究。设置：美国的一个学术医疗中心。患者：所有从2008年11月至2011年1月住院的患者，均记录了病房生命体征。这些患者被分为三个队列：患者谁遭受心脏骤停的病房，患者谁有病房重症监护病房转移，和患者谁没有这些结果（对照组）。干预措施：无测量和主要结果：病房生命体征从入院到出院，重症监护病房转移，或病房心脏骤停提取的医疗记录。多变量逻辑回归用于预测心脏骤停，并使用回归系数计算心脏骤停风险分诊评分。该模型进行了验证，通过比较其准确性检测重症监护室转移到修改后的预警评分。每个患者在心脏骤停、重症监护室转移或出院前的最大评分用于比较两种模型之间的受试者工作特征曲线下面积。88名心脏骤停患者，2，820名重症监护室转移和44，519名对照被纳入研究。心脏骤停风险分类评分比改良早期预警评分更准确地预测心脏骤停（受试者工作特征曲线下面积0.84 vs. 0.76; p = .001）。在特异性为89.9%时，心脏骤停风险分类评分的敏感性为53.4%，而改良早期预警评分的敏感性为47.7%。心脏骤停风险分诊评分预测重症监护室转移也优于改良早期预警评分（受试者工作特征曲线下面积0.71 vs. 0.67; p < .001）。结论：心脏骤停风险分诊评分比改良早期预警评分更简单，更准确地检测心脏骤停和重症监护室转移。该工具的实施可能会降低快速反应团队的资源利用率，并提供一个更好的机会，以改善患者的结果比修改后的预警评分。(Crit Care Med 2012; 40：2102-2108）
Objective: Rapid response team activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage score to predict cardiac arrest and compared it to the Modified Early Warning Score, a commonly cited rapid response team activation criterion.Design: A retrospective cohort study.Setting: An academic medical center in the United States.Patients: All patients hospitalized from November 2008 to January 2011 who had documented ward vital signs were included in the study. These patients were divided into three cohorts: patients who suffered a cardiac arrest on the wards, patients who had a ward to intensive care unit transfer, and patients who had neither of these outcomes (controls).Interventions: None.Measurements and Main Results: Ward vital signs from admission until discharge, intensive care unit transfer, or ward cardiac arrest were extracted from the medical record. Multivariate logistic regression was used to predict cardiac arrest, and the cardiac arrest risk triage score was calculated using the regression coefficients. The model was validated by comparing its accuracy for detecting intensive care unit transfer to the Modified Early Warning Score. Each patient's maximum score prior to cardiac arrest, intensive care unit transfer, or discharge was used to compare the areas under the receiver operating characteristic curves between the two models. Eighty-eight cardiac arrest patients, 2,820 intensive care unit transfers, and 44,519 controls were included in the study. The cardiac arrest risk triage score more accurately predicted cardiac arrest than the Modified Early Warning Score (area under the receiver operating characteristic curve 0.84 vs. 0.76; p = .001). At a specificity of 89.9%, the cardiac arrest risk triage score had a sensitivity of 53.4% compared to 47.7% for the Modified Early Warning Score. The cardiac arrest risk triage score also predicted intensive care unit transfer better than the Modified Early Warning Score (area under the receiver operating characteristic curve 0.71 vs. 0.67; p < .001).Conclusions: The cardiac arrest risk triage score is simpler and more accurately detected cardiac arrest and intensive care unit transfer than the Modified Early Warning Score. Implementation of this tool may decrease rapid response team resource utilization and provide a better opportunity to improve patient outcomes than the modified early warning score. (Crit Care Med 2012; 40:2102-2108)