Combinations of early signs of critical illness predict in-hospital death - The SOCCER Study (signs of critical conditions and emergency responses)

被引:66
作者
Harrison, Gordon A. [1 ]
Jacques, Theresa
McLaws, Mary-Louise
Kilborn, Gabrielle
机构
[1] Univ NSW, Discipline Anaesthet Intens Care & Emergency Med, Sydney, NSW, Australia
[2] St Vincents Hosp, Dept Anaesthet, Sydney, NSW 2010, Australia
[3] St George Hosp, Intens Care Unit, Sydney, NSW 2217, Australia
[4] Univ New S Wales, Sch Publ Hlth & Community Med, Hosp Infect Epidemiol & Surveillance Unit, Sydney, NSW 2052, Australia
[5] Prince Wales Hosp, CNC, Sydney, NSW 2052, Australia
关键词
medical emergency team; adult; outcome; prevention;
D O I
10.1016/j.resuscitation.2006.05.008
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with Late signs (LS) with in-hospital death. Methods: A cross-sectional survey was undertaken of 3046 non-do not attempt resuscitation adult admissions in 5 hospitals without MET over 14 days. The medical records were reviewed for recordings of 26 ES and 21 LS and in-hospital death. Combinations of ES with or without LS were examined as predictors of death. Global modified early warning scores (GMEWS) were calculated. Findings: ES with LS, plus LS only, had higher odd ratios than ES atone. Four combinations of ES were strongly associated with death: cardiovascular plus respiratory with decrease in urinary output, cardiovascular plus respiratory with a decrease in consciousness, respiratory with decrease in urinary output, and cardiovascular plus respiratory. In other combinations, recordings Of SPO2 90-95%, systolic blood pressure 80-100 mmHg or decrease in urinary output in turn occurring with one or more disturbed blood gas variable were associated with death. Compared with admissions whose GMEWS were 0-2, admissions with GMEWS 5-15 were 27.1 times more likely to die while those with GMEWS 3-4 were 6.5 times more likely. Conclusions: The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
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页码:327 / 334
页数:8
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