Buist M D, Jarmolowski E, Burton P R, Bernard S A, Waxman B P, Anderson J
Dandenong Hospital, VIC.
Med J Aust. 1999 Jul 5;171(1):22-5. doi: 10.5694/j.1326-5377.1999.tb123492.x.
To investigate the nature and duration of clinical instability (i.e., abnormalities in simple physical observations or laboratory test results) in hospital patients before a "critical event" (i.e., a cardiac arrest or an unplanned admission to intensive care).
Retrospective survey of medical records of all patients having critical events (CEs) over 12 months. Data on hospital and Intensive Care Unit (ICU) patients were obtained for comparison with the study population.
A 300-bed metropolitan teaching hospital with a seven-bed ICU.
All patients having CEs over a 12-month period (January to December 1997).
Number of patients with clinical instability before a CE; duration of clinical instability before a CE; number of medical reviews of each patient before a CE; mortality rate and length of hospital stay for all patients.
There were 122 CEs in 112 patients (median, 1; range, 1-4). Of the CEs, 79 were unplanned ICU admissions (14 subsequent to cardiac arrest calls), and 43 were cardiac arrest calls not resulting in ICU admission. Each CE was preceded by a median of two (range, 0-9) criteria for clinical instability. The median duration of instability before a CE was 6.5 hours (range, 0-432 hours), and in that time a median of two (range, 0-13) medical reviews took place. The incidence of CEs in the total hospital population (122 CEs/19,853 admissions) and in ICU patients (79 unplanned admissions/515 admissions) was 0.6% and 15%, respectively. There were 70 deaths (62%) among the 112 patients, compared with a total of 392 deaths (2% of admissions) in the hospital, of which 107 were in ICU.
Very few patients suffer a CE while in hospital. However, those who do frequently manifest abnormalities in simple physical observations and laboratory test results before the CE. More rapid intervention in response to warning signs might provide a better outcome for these patients.
调查在“危急事件”（即心脏骤停或计划外入住重症监护病房）发生前，住院患者临床不稳定（即简单体格检查或实验室检查结果异常）的性质和持续时间。
对12个月内发生危急事件（CE）的所有患者的病历进行回顾性调查。获取医院和重症监护病房（ICU）患者的数据以与研究人群进行比较。
一家拥有300张床位的大都市教学医院，设有一个7张床位的ICU。
12个月期间（1997年1月至12月）发生CE的所有患者。
CE发生前临床不稳定的患者数量；CE发生前临床不稳定的持续时间；CE发生前每位患者的医学评估次数；所有患者的死亡率和住院时间。
112例患者发生了122次CE（中位数为1；范围为1 - 4）。其中，79次为计划外入住ICU（14次发生在心脏骤停呼叫后），43次为心脏骤停呼叫但未导致入住ICU。每次CE发生前，临床不稳定标准的中位数为2条（范围为0 - 9条）。CE发生前不稳定的中位数持续时间为6.5小时（范围为0 - 432小时），在此期间，医学评估的中位数为2次（范围为0 - 13次）。CE在全院总人群（122次CE / 19853例入院）和ICU患者中的发生率（79次计划外入住 / 515例入院）分别为0.6%和15%。112例患者中有70例死亡（62%），而医院总死亡人数为392例（占入院人数的2%），其中107例在ICU。
住院期间很少有患者发生CE。然而，发生CE的患者在事件发生前常常在简单体格检查和实验室检查结果中表现出异常。对警示信号进行更快速的干预可能会为这些患者带来更好的结果。
