Duckitt R W, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, Forni L G
Acute Medical Unit, Worthing Hospital, Worthing, West Sussex, UK.
Br J Anaesth. 2007 Jun;98(6):769-74. doi: 10.1093/bja/aem097. Epub 2007 Apr 30.
Several physiological scoring systems (PSS) have been proposed for identifying those at risk of deterioration. However, the chosen specific physiological values chosen and the scores allocated have not been prospectively validated. In this study, we investigate the relative contributions of the ventilatory frequency, heart rate, arterial pressure, temperature, oxygen saturation, and conscious level to mortality in order to devise a robust scoring system. All data were collected on admission to the emergency unit. Precise 'intervention-calling scores' could then be derived to trigger interventions.
Our observational, population-based single-centred study took place in a 602-bedded district general hospital. Patients admitted to the emergency care unit at Worthing general hospital during an initial study period between July and November 2003 (n = 3184) and a further validation period between October and November 2005 (n = 1102) were included.
Multivariate logistic regression analysis demonstrated that a ventilatory frequency > or = 20 min(-1), heart rate > or =102 min(-1), systolic blood pressure < or = 99 mm Hg, temperature <35.3 degrees C, oxygen saturation < or = 96%, and disturbed consciousness were associated with an increase in mortality. The Worthing PSS was developed from the regression coefficients associated with each variable. The model showed good discrimination with an area under the receiver operating characteristic curve, 0.74, excluding age as a variable. The discrimination of this system was significantly better than the early-warning scoring system.
A simple validated scoring system to predict mortality in medical patients with precise 'intervention-calling scores' has been developed.
已经提出了几种生理评分系统（PSS）用于识别病情恶化风险人群。然而，所选择的特定生理值以及分配的分数尚未经过前瞻性验证。在本研究中，我们调查了呼吸频率、心率、动脉压、体温、血氧饱和度和意识水平对死亡率的相对贡献，以设计一个可靠的评分系统。所有数据均在患者入院急诊时收集。然后可以得出精确的“干预呼叫分数”以触发干预措施。
我们基于人群的单中心观察性研究在一家拥有602张床位的地区综合医院进行。纳入了2003年7月至11月初始研究期间（n = 3184）以及2005年10月至11月进一步验证期间（n = 1102）在沃辛综合医院急诊室就诊的患者。
多因素逻辑回归分析表明，呼吸频率≥20次/分钟、心率≥102次/分钟、收缩压≤99mmHg、体温<35.3℃、血氧饱和度≤96%以及意识障碍与死亡率增加相关。沃辛PSS是根据与每个变量相关的回归系数制定的。该模型显示出良好的区分度，受试者工作特征曲线下面积为0.74（不将年龄作为变量）。该系统的区分度明显优于早期预警评分系统。
已经开发出一种简单且经过验证的评分系统，用于预测内科患者的死亡率，并具有精确的“干预呼叫分数”。
