记录快速反应系统传入支衰竭及相关患者转归。
Documenting Rapid Response System afferent limb failure and associated patient outcomes.
机构信息
Royal Adelaide Hospital, Adelaide, SA, Australia.
出版信息
Resuscitation. 2011 Jul;82(7):810-4. doi: 10.1016/j.resuscitation.2011.03.019. Epub 2011 Mar 29.
OBJECTIVE
Describe afferent limb failure (ALF), defined as documented Rapid Response System (RRS) calling criteria, but no associated call, in the 24h prior to an event.
METHODS
Retrospective medical record and database review. Adult in-patients whose hospital length of stay (LOS) was greater than 24h, an event being a cardiac arrest, Medical Emergency Team (MET) call or unanticipated Intensive Care Unit (ICU) admission.
RESULTS
Over 6 months, there were 443 patients with 575 events, of which 35 (6.1%) were cardiac arrests, 395 (68.7%) MET calls, and 145 (25.2%) ICU admissions. 131 (22.8%) events had documented ALF, of which 47/131 (35.9%) had documented criteria across more than one time period. Patients with ALF, compared to those without ALF, were significantly more likely to have an unanticipated ICU admission (45/131 (34.4%) vs 100/443 (22.5%), p=0.01), but be of similar age (71 years vs 72 years, p=0.44), male gender (51.1% vs 53.2%, p=0.38), APACHE 2 score (22.8 vs 21.4, p=0.67), predicted risk of death (0.394 vs 0.367, p=0.55), ICU LOS (2 days vs 2 days, p=0.56), likelihood of not-for-resuscitation order during an event (4/131 (3.4%) vs 22/444 (5.0%), p=0.34), and hospital mortality (42/107 (39.3%) vs 125/236 (37.2%), p=0.70). Hospital mortality for patients with ALF across multiple, compared to single time periods was higher, 21/40 (52.5%) vs 22/69 (31.9%), p=0.03.
CONCLUSIONS
RRS ALF is a useful performance measure for a mature RRS, and is associated with unanticipated ICU admissions. The duration of, and not timing of, ALF criterion occurrence may affect hospital mortality.
目的
描述传入支衰竭（ALF），定义为记录的快速反应系统（RRS）调用标准，但在事件发生前 24 小时内没有相关调用。
方法
回顾性病历和数据库审查。住院时间超过 24 小时的成年住院患者，事件为心脏骤停、医疗应急小组（MET）呼叫或意外重症监护病房（ICU）入院。
结果
在 6 个月的时间里，有 443 名患者发生了 575 起事件，其中 35 起（6.1%）为心脏骤停，395 起（68.7%）为 MET 呼叫，145 起（25.2%）为 ICU 入院。131 例（22.8%）事件有记录的 ALF，其中 47/131 例（35.9%）在多个时间段有记录的标准。与没有 ALF 的患者相比，有 ALF 的患者更有可能发生意外的 ICU 入院（45/131（34.4%）比 100/443（22.5%），p=0.01），但年龄相似（71 岁比 72 岁，p=0.44），男性比例（51.1%比 53.2%，p=0.38），急性生理学和慢性健康评估 2 评分（22.8 比 21.4，p=0.67），死亡预测风险（0.394 比 0.367，p=0.55），ICU 住院时间（2 天比 2 天，p=0.56），事件期间不进行复苏的可能性（4/131（3.4%）比 22/444（5.0%），p=0.34），以及医院死亡率（42/107（39.3%）比 125/236（37.2%），p=0.70）。与单一时间段相比，多个时间段发生 ALF 的患者的医院死亡率更高，21/40（52.5%）比 22/69（31.9%），p=0.03。
结论
RRS 的 ALF 是成熟的 RRS 的一个有用的绩效衡量标准，与意外的 ICU 入院有关。ALF 标准发生的持续时间而不是时间可能会影响医院死亡率。
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