Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Br J Surg. 2012 Feb;99(2):192-7. doi: 10.1002/bjs.7777. Epub 2011 Dec 20.
Early warning scores (EWS) may aid the prediction of major adverse events in hospitalized patients. Recently, an expanded EWS was introduced in the Netherlands. The aim of this study was to assess the relationship between this EWS and the occurrence of major adverse clinical events during hospitalization of patients admitted to a general and trauma surgery ward.
This was a prospective cohort study of consecutive patients admitted to the general and trauma surgery ward of a university medical centre (March-September 2009). Follow-up was limited to the time the patient was hospitalized. Logistic regression analysis was used to assess the relationship between the EWS and the occurrence of the composite endpoint consisting of death, reanimation, unexpected intensive care unit admission, emergency surgery and severe complications. Performance of the EWS was analysed using sensitivity, specificity, predictive values and receiver operating characteristic (ROC) curves.
A total of 572 patients were included. During a median follow-up of 4 days, 46 patients (8.0 per cent) reached the composite endpoint (two deaths, two reanimations, 17 intensive care unit admissions, 44 severe complications, one emergency operation). An EWS of at least 3, adjusted for baseline American Society of Anesthesiology classification, was associated with a significantly higher risk of reaching the composite endpoint (odds ratio 11·3, 95 per cent confidence interval (c.i.) 5·5 to 22·9). The area under the ROC curve was 0·87 (95 per cent c.i. 0·81 to 0·93). When considering an EWS of at least 3 to be a positive test result, sensitivity was 74 per cent and specificity was 82 per cent.
An EWS of 3 or more is an independent predictor of major adverse events in patients admitted to a general and trauma surgery ward.
早期预警评分（EWS）可辅助预测住院患者的重大不良事件。最近，荷兰引入了一种扩展的 EWS。本研究旨在评估该 EWS 与入住普通外科和创伤外科病房患者住院期间发生重大不良临床事件的关系。
这是一项前瞻性队列研究，连续纳入入住大学医学中心普通外科和创伤外科病房的患者（2009 年 3 月至 9 月）。随访时间限于患者住院期间。采用逻辑回归分析评估 EWS 与死亡、复苏、意外转入重症监护病房、急诊手术和严重并发症组成的复合终点发生的关系。采用敏感性、特异性、预测值和受试者工作特征（ROC）曲线分析 EWS 的性能。
共纳入 572 例患者。中位随访 4 天期间，46 例（8.0%）达到复合终点（2 例死亡、2 例复苏、17 例转入重症监护病房、44 例严重并发症、1 例急诊手术）。校正基线美国麻醉医师协会分级后，EWS 至少为 3 与达到复合终点的风险显著增加相关（比值比 11.3，95%置信区间 5.5 至 22.9）。ROC 曲线下面积为 0.87（95%置信区间 0.81 至 0.93）。当将 EWS 至少 3 视为阳性测试结果时，敏感性为 74%，特异性为 82%。
EWS 至少为 3 是普通外科和创伤外科病房患者发生重大不良事件的独立预测因子。
