Validation of Early Warning Systems for Severe Maternal Morbidity and Individualised Prediction of Severe Maternal Morbidity within Ethnic Groups

研究的目的是什么？这项研究是为了了解最好的系统，以识别所有种族的妇女在怀孕期间或怀孕后的不适。这将确保保健不平等不会影响对医疗问题的认识，并将使治疗更快，以防止严重疾病和死亡。这项研究是关于什么的？“早期预警评分”是一个用于日常医疗保健的系统，用于识别有严重疾病风险的妇女。严重疾病包括与妊娠有关的问题，如感染、高血压和出血，以及与妊娠无关的医学问题。住院妇女的脉搏、血压、呼吸频率、体温和含氧量等“生命体征”每天都要测量几次。医护人员根据这些生命体征计算出“早期预警评分”。这个数字越高，在短期内患严重疾病的风险就越大，妇女的护理就越紧迫。目的是确保疾病的快速诊断和治疗。问题在于，这些“早期预警分数”的证据不足。分数被开发、修改和使用，而没有测试它们有多好。因此，医院在产科使用超过100种不同的分数，这意味着如何计算严重疾病的风险是不可接受的。此外，在英国，女性严重不适和死亡的风险因种族而异。没有测试早期预警分数，以确保他们在不同的种族群体中表现良好。如果我们不衡量和理解差异，那么我们就有可能创造出对大多数女性有效而不是对所有女性有效的早期预警分数。第二，有大量重要和容易获得的信息没有包括在预警分数中。例如，女性的年龄、身体质量指数和医疗问题将有助于解释她的生命体征，更好地了解她的患病风险。如果这些信息有助于解释种族群体之间的差异和预防严重疾病，就应该加以利用。研究将如何进行？首先，我需要理解为什么某些种族的女性患重病的风险更高。因此，我将深入审查现有的科学文献，以确定不同种族群体中最重要的风险因素。我也需要了解预警评分在现实生活中是如何使用的，所以我会回顾那些有异常生命体征的女性的医疗记录和访谈，并采访医护人员。我想确保早期预警评分有助于公平地治疗所有女性的疾病。我将使用一大群女性的电子医疗记录信息来测试现有的分数是否适用于每个种族。然后，我将采用一些最复杂的早期预警系统，并测试在个别少数民族群体中增加重要的额外风险因素是否会使他们的表现更公平。谁将参与这项研究？本项研究的设计咨询了来自不同种族背景、在怀孕期间或之后患有严重疾病的妇女。他们将参与进行研究，并在关键点上完善研究计划。将通过研讨会活动促进参与。公众和医疗保健决策者将参与和更新整个研究。调查结果和建议将在公众和社区、来自不同医疗保健团体的专业委员会和患者倡导团体之间共享。

What is the aim of the research?This research is about understanding the best system to identify women from all ethnic groups who are unwell during or after pregnancy. This will ensure health inequalities do not affect the recognition of medical problems and will enable faster treatment to prevent severe illness and death.What is the research about?The 'early warning score' is a system used in everyday medical care to identify women at risk of severe illness. Severe illness includes pregnancy-related problems like infection, high blood pressure, and bleeding, as well as medical problems unrelated to pregnancy. The 'vital signs' of the pulse, blood pressure, rate of breathing, temperature and oxygen level are measured several times per day for women in hospital. Healthcare workers calculate an 'early warning score' based on these vital signs. The higher the number, the greater the risk of severe illness in the short term, and the more urgent the woman's care becomes. The purpose is to ensure fast diagnosis and treatment of illness.The problem is that the evidence for these 'early warning scores' is poor. Scores are developed, changed, and used without testing how good they are. Consequently, hospitals use over a hundred different scores in obstetrics and this means that how the risk of severe illness is calculated varies unacceptably. Additionally, in the UK the risk of a woman becoming severely unwell and dying is different based on her ethnicity. No early warning scores have been tested to make sure they perform well in different ethnic groups. If we do not measure and understand differences then we risk creating early warning scores that work for most women but not all women.Second, there is a large amount of important and easily-accessible information that is not included in early warning scores. For example, a woman's age, body mass index, and medical problems would help to interpret her vital signs and understand her risk of illness better. This information should be used if it can help to account for differences between ethnic groups and prevent severe illness.How will the research be undertaken?Initially, I need to understand why women from some ethnic groups are at higher risk of severe illness. I will therefore review the existing scientific literature in depth to identify the most important risk factors in different ethnic groups. I also need to understand how early warning scores are used in real life, so I will review the medical records and interviews of women who had abnormal vital signs, and interview healthcare workers. I want to make sure early warning scores help treat illness in all women fairly. I will test whether existing scores work well in each ethnic group using information from the electronic medical records of a large group of women. I will then take some of the most sophisticated early warning systems and test whether adding extra risk factors that are important within individual ethnic minority groups makes them perform more fairly.Who will be involved in the research?Women from different ethnic backgrounds who have experienced severe illness during or after pregnancy have been consulted on the design of the research. They will be involved in conducting the research, and refining the research plan at key points. Involvement will be facilitated through a workshop event. The public and healthcare decision-makers will be involved and updated throughout the research. Findings and recommendations will be shared among the public and community, professional committees from different healthcare groups, and patient advocacy groups.