The objective medical emergency team activation criteria: A case-control study
The objective medical emergency team activation criteria: A case-control study
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DOI：
10.1016/j.resuscitation.2006.08.020
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发表时间：
2007-04-01
期刊：
影响因子：
6.5
通讯作者：
Flabouris, Arthas
中科院分区：
文献类型：
--
作者：
Cretikos, Michelle;Chen, Jack;Flabouris, Arthas
目的：评估预先定义的临床标准识别随后发生心脏骤停、计划外重症监护病房入住或意外死亡的患者的能力；确定修改后的标准识别这些患者的能力。设计：巢式匹配病例对照研究。环境：澳大利亚七家公立医院。患者和参与者：450例病例和520例对照，年龄、性别、医院和医院病房相匹配。干预措施:没有。测量和结果：测量最高和最低呼吸和心率，最低收缩压，气道威胁的存在，癫痫发作或格拉斯哥昏迷评分大于2分的降低以及三种不良事件的发生率。结合心率大于140、呼吸频率大于36、收缩压小于90mmhg和格拉斯哥昏迷评分降低2分以上的患者，识别不良事件的敏感性为49.1%(44.4-53.8%)，特异性为93.7%(91.2-95.6%)，阳性预测值为9.8%（8.7-11.1%）。增加气道威胁、癫痫发作、低呼吸率和低心率并没有显著提高敏感性（50.4%;45.7-55.2%）。在修改呼吸频率、心率和收缩压的临界值后，可达到的最佳阳性预测值仍低于16%。结论：结合呼吸频率、心率、收缩压和意识水平对心脏骤停、计划外重症监护入院或意外死亡风险患者具有高特异性；然而，即使在修改激活标准临界值后，敏感性和阳性预测值也相对较低。2006爱思唯尔爱尔兰有限公司版权所有。
Objective: To evaluate the ability of pre-defined clinical criteria to identify patients who subsequently suffer cardiac arrest, unplanned intensive care unit admission or unexpected death; to determine the ability of modified criteria to identify these patients.Design: Nested, matched case-control study.Setting: Seven Australian public hospitals.Patients and participants: Four hundred and fifty cases and 520 controls matched for age, sex, hospital, and hospital ward.Interventions: None.Measurements and results: Highest and lowest respiratory and heart rates, lowest systolic blood pressure, presence of threatened airway, seizures or decrease in Glasgow Coma Scale score of greater than two points and incidence of the three adverse events were measured. Combining a heart rate greater than 140, respiratory rate greater than 36, a systolic blood pressure less than 90 mmHg and a greater than two point reduction in the Glasgow Coma Scale identified adverse events with a sensitivity of 49.1% (44.4-53.8%), specificity of 93.7% (91.2-95.6%), and positive predictive value of 9.8% (8.7-11.1%). Adding threatened airway, seizures, low respiratory rate and low heart rate did not substantially improve sensitivity (50.4%; 45.7-55.2%). After modifying the cut-off values for respiratory rate, heart rate and systolic blood pressure, the best achievable positive predictive value remained below 16%.Conclusions: In combination, the respiratory rate, heart rate, systolic blood pressure, and level of consciousness identify patients at risk of cardiac arrest, unplanned intensive care admission or unexpected death with high specificity; however the sensitivity and positive predictive value are relatively low, even after modification of the activation criteria cut-off values. (c) 2006 Elsevier Ireland Ltd. All rights reserved.