预先医院早期预警得分预测使用救护车的患者的死亡率
Tim Alex Lindskou1, Logan Morgan Ward2, Morten Breinholt Søvsø1,3
1Centre for Prehospital and Emergency Research, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
JAMA network open
|August 9, 2023
概括
早期预警分数 (EWS) 对医院前患者的预测值中等. 需要新的EWS来更好地识别紧急医疗环境中的风险.
科学领域:
- 紧急医疗 紧急医疗
- 在医院前的护理.
- 临床评分系统 临床评分系统
背景情况:
- 早期预警分数 (EWS) 主要是为医院内使用而设计的.
- 它们在医院前环境中的应用,特别是对高风险患者的应用,正在增加.
- 在大型,未经选择的医院前队列中验证对于临床实用性至关重要.
研究的目的:
- 验证各种EWS对成年救护车服务用户的死亡率和ICU入院的预测能力.
- 通过护理人员测量的初始生命体征来评估EWS性能.
主要方法:
- 一项涉及成人患者 (≥18岁) 使用北丹麦地区救护车服务的预后研究 (2016年7月 - 2020年12月).
- 根据第一个生命体征计算的EWS包括NEWS2,mNEWS,qSOFA,RETTS和DEPT.
- 分析了来自219,323次救护车服务遭遇的107,569名独特患者.
主要成果:
- NEWS2,mNEWS,RETTS和DEPT在30天死亡率方面表现相似的中等表现 (AUROC 0.67-0.68).
- qSOFA在30天死亡率方面表现较低 (AUROC 0.59).
- 所有EWS在所有结果的精度回忆曲线 (AUPRC) 下的面积都很低,这表明精度有限.
结论:
- 根据初始生命体征,EWS在未经选择的患者的医院前环境中显示出适度的预测性表现.
- 目前的EWS可能需要改进,或者需要新的系统来改进医院前分组和风险分层.
- 对为医院前使用量身定制的新型EWS进行进一步研究是有必要的.
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