在产前和产后入院期间的败血症查工具的性能特征
Melissa E Bauer1, Matt Fuller, Vesela Kovacheva
1Department of Anesthesiology and the Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Sutter Health Institute for Advancing Health Equity and the Center for Health Systems Research, Sutter Health, Sacramento, Common Spirit Health, the Department of Systems Clinical Informatics, Common Spirit Health, the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, and the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California; the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; and Wayne State University School of Medicine, Wayne, and the Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
孕期调整的败血症查工具最好用于预测从怀孕20周到产后3天的败血症,而非孕期调整的工具在怀孕早期和产后更好地执行. 总体而言,假阳性率仍然很高.
科学领域:
- 孕产妇健康 孕产妇健康
- 传染病预测传染病的预测
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 败血症在产前和产后期间对母亲的健康构成重大风险.
- 准确和及时的败血症查对于改善母亲的结果至关重要.
- 现有的查工具需要在不同的妊娠和产后阶段对最佳性能进行评估.
研究的目的:
- 评估目前用于产前和产后再入院的败血症查工具的性能.
- 为了比较妊娠调整和非妊娠调整查标准的有效性.
- 为了确定最佳查策略,用于不同阶段的怀孕和产后期.
主要方法:
- 一项病例控制研究利用了来自多家医院的2016-2021年电子健康记录数据.
- 败血症病例与非败血症对照对产前和产后入院患者进行了匹配,最高可达42天.
- 评估的工具包括CMQCC,非怀孕调整的SIRS,MEWC,UKOSS产科SIRS和MEWT,根据妊娠/产后时间分析表现.
主要成果:
- 非怀孕调整的SIRS显示,怀孕早期和产后晚期 (>3天) 的C统计数据更高.
- 妊娠调整工具 (CMQCC,UKOSS) 从怀孕20周到产后早期 (<3天) 显示出优异的C统计数据.
- MEWC具有高灵敏度,但也具有最高的错误阳性率;妊娠调整工具具有最低的错误阳性率.
结论:
- 非怀孕调整的败血症查工具在怀孕早期和产后晚期入院时更有效.
- 根据怀孕情况调整的工具提高了敏感性,并减少了从怀孕20周到产后早期的假阳性.
- 所有工具的高整体假阳性率需要进一步改进毒症查在孕产妇护理.
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