Department of Critical Care, The Christie, Wilmslow Road, Manchester M20 4BX, UK.
QJM. 2012 Nov;105(11):1083-8. doi: 10.1093/qjmed/hcs138. Epub 2012 Aug 1.
Patients at risk of rapid deterioration and critical illness often have preceding changes in physiological parameters. Track and trigger systems, such as the Modified Early Warning Score (MEWS) used in the UK, have been demonstrated to have some utility in identifying these patients particularly among general medical and surgical patients.
Assess the effectiveness of MEWS and the proposed (NHS Early Warning Score) in oncology patients. Identify the key physiological parameters that predict outcome in this cohort.
We performed a retrospective analysis at a specialist oncology hospital in the North West of England.
The data for 840 patients reviewed by the Outreach Team between April 2009 and January 2011 was analysed. The effectiveness of the MEWS in predicting Critical Care admission and 30 day mortality was assessed. Statistical analysis to identify the key physiological parameters in predicting these two outcomes was also performed.
The MEWS score was statistically significant in predicting both outcome measures (CCU admission P = 0.037 and 30 day mortality P = 0.004). Respiratory rate (P = 0.0003/P = 0.0001) and temperature (P = 0.033/P ≤ 0.0001) were the key physiological variables in predicting clinical deterioration. Blood pressure (P = 0.999/P = 0.619) and pulse rate (P = 0.446/P = 0.051) did not have statistical significance in predicting either outcome. However, analysis of receiver operator curves showed that MEWS had poor value in predicting both outcomes (0.55 and 0.6, respectively).
The currently used track and trigger systems have poor discriminatory value in identifying Oncological patients at risk of deterioration. An adapted score more focused upon the key predictive physiological parameters in this population needs to be developed to produce a more effective tool.
有快速恶化和患重病风险的患者通常在生理参数上会有先前的变化。跟踪和触发系统，如在英国使用的改良早期预警评分（MEWS），已经被证明在识别这些患者，特别是在一般内科和外科患者中具有一定的作用。
评估 MEWS 和拟议的（NHS 早期预警评分）在肿瘤患者中的有效性。确定该队列中预测结果的关键生理参数。
我们在英格兰西北部的一家专业肿瘤医院进行了回顾性分析。
分析了 2009 年 4 月至 2011 年 1 月期间外展团队审查的 840 名患者的数据。评估了 MEWS 在预测重症监护病房入院和 30 天死亡率方面的有效性。还进行了统计分析，以确定预测这两个结果的关键生理参数。
MEWS 评分在预测这两个结果测量指标（重症监护病房入院 P=0.037 和 30 天死亡率 P=0.004）方面均具有统计学意义。呼吸频率（P=0.0003/P=0.0001）和体温（P=0.033/P≤0.0001）是预测临床恶化的关键生理变量。血压（P=0.999/P=0.619）和脉搏率（P=0.446/P=0.051）在预测这两个结果方面均无统计学意义。然而，接受者操作特征曲线分析表明，MEWS 在预测这两个结果方面的价值都较低（分别为 0.55 和 0.6）。
目前使用的跟踪和触发系统在识别有恶化风险的肿瘤患者方面的区分度较差。需要开发一种更侧重于该人群中关键预测生理参数的改良评分，以提供更有效的工具。
