Goldhill D R, McNarry A F
The Anaesthetics Unit, The Royal London Hospital, London E1 1BB, UK.
Br J Anaesth. 2004 Jun;92(6):882-4. doi: 10.1093/bja/aeh113. Epub 2004 Apr 2.
Early warning scores using physiological measurements may help identify ward patients who are, or who may become, critically ill. We studied the value of abnormal physiology scores to identify high-risk hospital patients.
On a single day we recorded the following data from 433 adult non-obstetric inpatients: respiratory rate, heart rate, systolic pressure, temperature, oxygen saturation, level of consciousness, urine output for catheterized patients, age and inspired oxygen. We also noted the care required and given.
Twenty-six patients (6%) died within 30 days. They were significantly older than survivors (P<0.001). Their median hospital stay was 26 days (interquartile range 16-39). Mortality increased with the number of physiological abnormalities (P<0.001), being 0.7% with no abnormalities, 4.4% with one, 9.2% with two and 21.3% with three or more. Patients receiving a lower level of care than desirable also had an increased mortality (P<0.01). Logistic regression modelling identified level of consciousness, heart rate, age, systolic pressure and respiratory rate as important variables in predicting outcome.
Simple physiological observations identify high-risk hospital inpatients. Those who die are often inpatients for days or weeks before death, allowing time for clinicians to intervene and potentially change outcome. Access to critical care beds could decrease mortality.
使用生理测量指标的早期预警评分可能有助于识别已患或可能患危重症的病房患者。我们研究了异常生理评分在识别高危住院患者方面的价值。
在同一天，我们记录了433名成年非产科住院患者的以下数据：呼吸频率、心率、收缩压、体温、血氧饱和度、意识水平、导尿患者的尿量、年龄和吸入氧。我们还记录了所需及已提供的护理情况。
26名患者（6%）在30天内死亡。他们的年龄显著大于存活患者（P<0.001）。他们的中位住院时间为26天（四分位间距16 - 39天）。死亡率随生理异常数量的增加而升高（P<0.001），无异常者死亡率为0.7%，有一项异常者为4.4%，有两项异常者为9.2%，有三项或更多异常者为21.3%。接受的护理水平低于期望水平的患者死亡率也更高（P<0.01）。逻辑回归模型确定意识水平、心率、年龄、收缩压和呼吸频率是预测预后的重要变量。
简单的生理观察可识别高危住院患者。死亡患者在死亡前通常已住院数天或数周，这使临床医生有时间进行干预并可能改变预后。获得重症监护床位可降低死亡率。
