令人惊的问题:在未经选择的急诊室人群中预测准确度 - - 一项针对护士和医生的前性研究
Maurice Theunissen1, Sacha Lardenoye2, Marieke H J van den Beuken-van Everdingen1
1Center of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands.
Annals of medicine
|July 16, 2025
概括
惊喜问题 (SQ) 是预测急诊室 (ED) 患者死亡率的可靠工具,特别是在高危人群中. 对12个月死亡率的预后准确度特别高,支持其用于指导ED护理.
科学领域:
- 紧急医疗 紧急医疗
- 预测的准确性 预测的准确性
- 临床决策支持 临床决策支持
背景情况:
- 医疗专业人员使用"意外问题" (SQ) 来估计患者的死亡风险.
- 本研究重点关注SQ在急诊室 (ED) 设置中的预后准确性和专业间协议.
研究的目的:
- 评估SQ对未选成人ED患者3个月和12个月死亡率的预后准确性.
- 在高风险子组 (年龄≥50岁,医疗患者) 中评估SQ的准确性.
- 在使用SQ时,确定护士和医生之间的协议.
主要方法:
- 一项前性研究,涉及护士和医生对3个月 (SQ3) 和12个月 (SQ12) 死亡率进行SQ评分.
- 计算的指标包括接收器运行特征曲线下的面积 (AU-ROC),灵敏度,特异性和负预测值 (NPV).
- 卡帕的价值和绝对的协议被用来评估跨专业的协议.
主要成果:
- 评估了1958名患者;12个月死亡率为13.9%.
- 在SQ12的AU-ROC为0.722 (护士) 和0.847 (医生). 对SQ12的敏感性为54.1-60.8%,具有高的NPV.
- 护士和医生之间的协议对于SQ3 (kappa 0.255) 是公平的,对于SQ12 (kappa 0.461) 是中等的.
结论:
- 在ED中,SQ是一个有价值的预后工具,具有强大的12个月准确性,特别是在高风险患者中.
- 该SQ可以帮助ED内部的临床决策,特别是对于脆弱的患者群体.
- 护士和医生之间公平到适度的协议表明了标准化使用的潜力.
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