超越非计划性ICU转移:将病情恶化的修订定义与患者结果联系起来
Thomas F Byrd1,2,3, Tom A Phelan4, Nicholas E Ingraham2,5
1Division of Hospital Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.
Critical care medicine
|June 4, 2024
概括
住院患者临床恶化的新电子描述器预测死亡率,并比目前的方法提前2.5小时识别下降. 该工具增强了早期预警系统,以改善患者的治疗结果.
科学领域:
- 医疗信息学 医疗信息学
- 临床决策支持 临床决策支持
- 患者安全 患者安全
背景情况:
- 目前用于识别住院患者临床恶化的方法往往缺乏及时性和预测准确性.
- 早期发现患者衰退对于改善治疗结果和降低死亡率至关重要.
研究的目的:
- 开发和验证临床恶化的电子描述器.
- 预测短期死亡率并比现有定义更早地确定患者病情恶化.
主要方法:
- 使用探索性记录审查,定量分析和回归分析进行回顾性研究.
- 来自12家医院卫生系统的成年患者的数据 (2018-2022年).
- 基于临床触发事件的恶化的修订电子定义的开发.
主要成果:
- 修订后的定义,包括呼吸衰竭,出血和低血压的信号,与7天死亡率增加12.5倍的可能性有关.
- 符合修订后定义的患者的住院时间延长了95.3%.
- 与ICU转移相比,检测到恶化的中位数是157分钟更早.
结论:
- 开发的电子描述符与短期死亡率和逗留时间密切相关.
- 这一修订后的定义识别了临床恶化明显早于当前标准.
- 在早期预警系统中实施可以提高及时性和准确性,以获得更好的患者护理.
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