The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team

被引:208
作者
Hodgetts, TJ [1 ]
Kenward, G
Vlachonikolis, IG
Payne, S
Castle, N
机构
[1] Selly Oak Hosp, Ctr Def Med, Birmingham B29 6JD, W Midlands, England
[2] Frimley Pk Hosp, Camberley GU16 5UJ, Surrey, England
[3] Univ Surrey, Biostat Unit, European Inst Hlth & Med Sci, Guildford GU2 5XH, Surrey, England
关键词
cardiac arrest; risk factors; medical emergency team; activation criteria;
D O I
10.1016/S0300-9572(02)00100-4
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: (1) To identify risk factors for in-hospital cardiac arrest: (2) to formulate activation criteria to alert a clinical response culminating in attendance by a Medical Emergency Team (MET); (3) to evaluate the sensitivity and specificity of the scoring system. Methods: Quasi-experimental design to determine prevalence of risk factors for cardiac arrest in the hospitalised population. Weighting of risk factors and formulation of activation criteria to alert a graded clinical response. ROC analysis of weighted cumulative scores to determine their sensitivity and specificity. Setting: An acute 700 bed district general hospital with 32348 adult admissions in 1999 and a catchment population of around 365 000. Subjects: 118 consecutive adult patients suffering primary cardiac arrest in-hospital and 132 non-arrest patients, randomly selected according to stratified randomisation by gender and age. Results: Risk factors for cardiac arrest include: abnormal respiratory rate (P = 0.013), abnormal breathing indicator (abnormal rate or documented shortness of breath) (P < 0.001), abnormal pulse (P < 0.001), reduced systolic blood pressure (P < 0.001). abnormal temperature (P < 0.001), reduced pulse oximetry (P < 0.001), chest pain (P < 0.001) and nurse or doctor concern (P < 0.001). Multivariate analysis of cardiac arrest cases identified three positive associations for cardiac arrest: abnormal breathing indicator (OR 3.49; 95% CI: 1.69-7.21), abnormal pulse (OR 4.07; 95% CI: 2.0-8.31) and abnormal systolic blood pressure (OR 19.92; 95% CI: 9.48-41.84). Risk factors were weighted and tabulated. The aggregate score determines the grade of clinical response. ROC analysis determined that a score of 4 has 89% sensitivity and 77% specificity for cardiac arrest; a score of 8 has 52% sensitivity and 99% specificity. All patients scoring greater than 10 suffered cardiac arrest. Conclusion: Risk factors for cardiac arrest have been identified, quantified and formulated into a table of activation criteria to help predict and avert cardiac arrest by alerting a clinical response. A graded clinical response has resulted in a tool that has both sensitivity and specificity for cardiac arrest. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
引用
收藏
页码:125 / 131
页数:7
相关论文
共 29 条
  • [21] Miller R.G., 1966, Simultaneous statistical inference
  • [22] Morgan RM., 1997, Clin Intensive Care, V8, P100, DOI DOI 10.3109/TCIC.8.2.93.110
  • [23] Rich K, 1999, Clin Nurse Spec, V13, P147, DOI 10.1097/00002800-199905000-00013
  • [24] RUBINS HB, 1983, CRIT CARE MED, V11, P61
  • [25] MEDICAL PATIENTS AT HIGH-RISK FOR CATASTROPHIC DETERIORATION
    SAX, FL
    CHARLSON, ME
    [J]. CRITICAL CARE MEDICINE, 1987, 15 (05) : 510 - 515
  • [26] CLINICAL ANTECEDENTS TO IN-HOSPITAL CARDIOPULMONARY ARREST
    SCHEIN, RMH
    HAZDAY, N
    PENA, M
    RUBEN, BH
    SPRUNG, CL
    [J]. CHEST, 1990, 98 (06) : 1388 - 1392
  • [27] SITH G, 2000, CARE CRIT ILL, V16, P198
  • [28] Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey
    Smith, AF
    Wood, J
    [J]. RESUSCITATION, 1998, 37 (03) : 133 - 137
  • [29] Smith S K, 1988, Image J Nurs Sch, V20, P12