Repeated vital sign measurements in the emergency department predict patient deterioration within 72 hours: a prospective observational study
Repeated vital sign measurements in the emergency department predict patient deterioration within 72 hours: a prospective observational study
复制标题
DOI：
10.1186/s13049-018-0525-y
复制
发表时间：
2018-07-13
影响因子：
3.3
通讯作者：
ter Maaten, Jan C.
中科院分区：
文献类型：
--
作者：
Quinten, Vincent M.;van Meurs, Matijs;ter Maaten, Jan C.
背景资料：超过五分之一的（艾德）感染或脓毒症患者在入院后72小时内恶化。令人惊讶的是，我们对生命体征与恶化的关系知之甚少，特别是在ED中。我们研究的目的是确定艾德中重复的生命体征测量是否可以区分72小时内恶化的患者和不会恶化的患者。我们在三级护理教学医院的艾德就诊的（疑似）感染或脓毒症患者中进行了一项前瞻性观察研究。生命体征（心率、平均动脉压（MAP）、呼吸频率和体温）在ED的前3小时内每隔30分钟测量一次。主要结局是入院后72小时内患者病情恶化，定义为发生急性肾损伤、肝功能衰竭、呼吸衰竭、重症监护病房入院或住院死亡。我们使用包括年龄、性别和合并症的基础模型进行逻辑回归分析。此后，我们使用入院时的值、随时间的变化及其变异性对每个生命体征进行单独的logistic回归分析。对于每个分析，比值比（OR）和受试者工作曲线（AUC）下的面积进行了计算。结果：在总共106（29.5%）的359例患者恶化72小时内入院。在此期间，18。艾德表现为感染者和脓毒症者的病情恶化率分别为33.3%和32.9%。与恶化相关的因素有：年龄（OR：1.02）、糖尿病史（OR：1.90）、入院时心率（OR：1.01）、MAP（OR：0.96）和呼吸频率（OR：1.05）、MAP（OR：1.04）和呼吸频率（OR：1.44）随时间的变化以及MAP的变异性（OR：1.06）。重复测量的心率和体温与恶化。结论：重复的生命体征测量在艾德是更好地识别患者在入院后72小时内恶化的风险比单一的生命体征测量在艾德入院。
Background: More than one in five patients presenting to the emergency department (ED) with (suspected) infection or sepsis deteriorate within 72 h from admission. Surprisingly little is known about vital signs in relation to deterioration, especially in the ED. The aim of our study was to determine whether repeated vital sign measurements in the ED can differentiate between patients who will deteriorate within 72 h and patients who will not deteriorate.Methods: We performed a prospective observational study in patients presenting with (suspected) infection or sepsis to the ED of our tertiary care teaching hospital. Vital signs (heart rate, mean arterial pressure (MAP), respiratory rate and body temperature) were measured in 30-min intervals during the first 3 h in the ED. Primary outcome was patient deterioration within 72 h from admission, defined as the development of acute kidney injury, liver failure, respiratory failure, intensive care unit admission or in-hospital mortality. We performed a logistic regression analysis using a base model including age, gender and comorbidities. Thereafter, we performed separate logistic regression analyses for each vital sign using the value at admission, the change over time and its variability. For each analysis, the odds ratios (OR) and area under the receiver operator curve (AUC) were calculated.Results: In total 106 (29.5%) of the 359 patients deteriorated within 72 h from admission. Within this timeframe, 18. 3% of the patients with infection and 32.9% of the patients with sepsis at ED presentation deteriorated. Associated with deterioration were: age (OR: 1.02), history of diabetes (OR: 1.90), heart rate (OR: 1.01), MAP (OR: 0.96) and respiratory rate (OR: 1.05) at admission, changes over time of MAP (OR: 1.04) and respiratory rate (OR: 1.44) as well as the variability of the MAP (OR: 1.06). Repeated measurements of heart rate and body temperature were not associated with deterioration.Conclusions: Repeated vital sign measurements in the ED are better at identifying patients at risk for deterioration within 72 h from admission than single vital sign measurements at ED admission.