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

这项研究的目的是什么？这项研究是关于了解最好的系统来识别所有种族的妇女在怀孕期间或怀孕后身体不适。这将确保健康不平等不会影响对医疗问题的认识，并使更快的治疗能够预防严重疾病和死亡。这项研究是关于什么的？早期预警评分是日常医疗中使用的一种系统，用于识别有严重疾病风险的女性。严重疾病包括与怀孕有关的问题，如感染、高血压和出血，以及与怀孕无关的医疗问题。医院里的女性每天都要数次测量脉搏、血压、呼吸频率、体温和血氧水平等“生命体征”。医护人员根据这些生命体征计算出“预警分数”。这个数字越高，在短期内患严重疾病的风险就越大，妇女的护理就变得越紧迫。这样做的目的是为了确保对疾病的快速诊断和治疗。问题是，这些“早期预警分数”的证据很差。分数的开发、更改和使用不需要测试它们的好坏。因此，医院在产科使用了100多种不同的评分，这意味着严重疾病风险的计算方式不同，令人无法接受。此外，在英国，女性身体严重不适并死亡的风险因其种族而异。没有对早期预警分数进行测试，以确保它们在不同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建对大多数女性但不是所有女性都有效的早期预警评分。第二，早期预警评分中没有包括大量重要的、容易获取的信息。例如，女性的年龄、体重指数和医疗问题将有助于解读她的生命体征，并更好地了解她患病的风险。如果这些信息可以帮助解释种族之间的差异并预防严重疾病，就应该使用它。如何进行研究？首先，我需要了解为什么一些民族的妇女患严重疾病的风险更高。因此，我将深入回顾现有的科学文献，以确定不同种族群体中最重要的风险因素。我还需要了解早期预警评分在现实生活中是如何使用的，因此我将回顾生命体征异常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对待所有女性的疾病。我将使用一大群女性的电子医疗记录中的信息来测试现有的分数在每个种族群体中是否有效。然后，我将采用一些最复杂的早期预警系统，并测试添加在个别少数民族群体中重要的额外风险因素是否会使他们的表现更加公平。谁将参与这项研究？研究设计咨询了来自不同种族背景、在怀孕期间或之后经历过严重疾病的妇女。他们将参与进行研究，并在关键点处细化研究计划。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并在整个研究过程中更新。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权益倡导团体之间分享。

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.