Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
Resuscitation. 2012 May;83(5):557-62. doi: 10.1016/j.resuscitation.2012.01.004. Epub 2012 Jan 14.
Physiological track and trigger scores have an established role in enhancing the detection of critical illness in hospitalized patients. Their potential to identify individuals at risk of clinical deterioration in the pre-hospital environment is unknown. This study compared the predictive accuracy of the Modified Early Warning Score (MEWS) with current clinical practice.
A retrospective observational cohort study of consecutive adult (≥16 yrs) emergency department attendances to a single centre over a two-month period. The outcome of interest was the occurrence or not of an adverse event within 24h of admission. Hospital pre-alerting was used as a measure of current critical illness detection and its accuracy compared with MEWS scores calculated from pre-hospital observations.
3504 patients were included in the study. 76 (2.5%) suffered an adverse event within 24 h of admission. Paramedics pre-alerted the hospital in 224 cases (7.3%). Clinical judgement demonstrated a sensitivity of 61.8% (95% CI 51.0-72.8%) with a specificity of 94.1% (95% CI 93.2-94.9%). MEWS was a good predictor of adverse outcomes and hence critical illness detection (AUC 0.799, 95% CI 0.738-0.856). Combination systems of MEWS and clinical judgement may be effective MEWS ≥4+clinical judgement: sensitivity 72.4% (95% CI 62.5-82.7%), specificity 84.8% (95% CI 83.52-86.1%).
Clinical judgement alone has a low sensitivity for critical illness in the pre-hospital environment. The addition of MEWS improves detection at the expense of reduced specificity. The optimal scoring system to be employed in this setting is yet to be elucidated.
生理轨迹和触发评分在增强对住院患者危急病症的检测方面具有重要作用。但其在院前环境中识别有临床恶化风险个体的能力尚不清楚。本研究比较了改良早期预警评分（MEWS）与当前临床实践的预测准确性。
这是一项在两个月期间对单中心连续成年（≥16 岁）急诊科就诊患者进行的回顾性观察性队列研究。感兴趣的结局是入院后 24 小时内是否发生不良事件。医院预先警示被用作当前危急病症检测的一种手段，并将其与从院前观察计算的 MEWS 评分进行比较。
本研究共纳入 3504 例患者。76 例（2.5%）在入院后 24 小时内发生不良事件。有 224 例（7.3%）患者的急救人员预先向医院发出警报。临床判断的敏感性为 61.8%（95%CI，51.0-72.8%），特异性为 94.1%（95%CI，93.2-94.9%）。MEWS 是不良结局和危急病症检测的良好预测指标（AUC 0.799，95%CI，0.738-0.856）。MEWS 与临床判断的组合系统可能是有效的 MEWS≥4+临床判断：敏感性 72.4%（95%CI，62.5-82.7%），特异性 84.8%（95%CI，83.52-86.1%）。
单独的临床判断在院前环境中对危急病症的敏感性较低。增加 MEWS 可提高检测率，但特异性降低。在这种情况下，最佳的评分系统尚待阐明。
