Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Crit Care Med. 2013 Mar;41(3):725-31. doi: 10.1097/CCM.0b013e3182711b94.
To evaluate characteristics and outcome of ICU patients admitted from general wards based on mode of admittance, via a rapid response team or conventional contact.
Observational prospective study.
General ICU of a university hospital.
: A total of 694 admissions to ICU from general wards.
None.
Between 2007 and 2009, two cohorts admitted to ICU from general wards were identified: those admitted by the rapid response team and those admitted in a conventional way. Patients admitted directly from the trauma room, the emergency department, operating room, other hospitals, or other ICUs were excluded. Of 694 admissions, 355 came through a rapid response team call. Rapid response team patients were older (p < 0.01), and they had more severe comorbidities, higher severity score (p < 0.01), and almost three times more often the diagnosis of severe sepsis (p < 0.01) than conventionally admitted patients. Rapid response team patients had higher ICU mortality and 30-day mortality with a crude odds ratio for mortality within 30 days of 1.57 (95% confidence interval 1.08-2.28). Adjusted for age and comorbidities however, the difference was no longer significant with an odds ratio of 1.11 (95% confidence interval 0.70-1.76).
This study suggests that the rapid response team is an important system for identifying complex patients in need of intensive care. More than half of ICU admissions from the wards came through a rapid response team call. Compared with conventional admissions, rapid response team patients had a high proportion of characteristics that could be related to a worse prognosis. Severe sepsis at the wards was mainly detected by the rapid response team and was the most common admitting diagnosis among the rapid response team patients. When adjusted for confounding factors, outcome between the groups did not differ, supporting the use of rapid response systems to identify deteriorating ward patients.
通过快速反应团队或常规联系，评估从普通病房转入 ICU 的患者的特征和转归。
观察性前瞻性研究。
大学医院综合 ICU。
共有 694 例从普通病房转入 ICU 的患者。
无。
在 2007 年至 2009 年期间，确定了两个从普通病房转入 ICU 的队列：通过快速反应团队转入的患者和常规方式转入的患者。排除直接从创伤室、急诊科、手术室、其他医院或其他 ICU 转入的患者。694 例转入患者中，有 355 例通过快速反应团队呼叫转入。快速反应团队患者年龄较大（p<0.01），合并症更严重，严重程度评分更高（p<0.01），且几乎三倍更常诊断为严重脓毒症（p<0.01），与常规转入患者相比。快速反应团队患者的 ICU 死亡率和 30 天死亡率更高，30 天内死亡率的粗比值比为 1.57（95%置信区间 1.08-2.28）。然而，调整年龄和合并症后，差异不再显著，比值比为 1.11（95%置信区间 0.70-1.76）。
这项研究表明，快速反应团队是识别需要重症监护的复杂患者的重要系统。超过一半的 ICU 病房转入是通过快速反应团队呼叫进行的。与常规转入相比，快速反应团队患者具有较高比例的可能与预后较差相关的特征。病房中的严重脓毒症主要通过快速反应团队检测，并且是快速反应团队患者中最常见的转入诊断。当调整混杂因素后，两组之间的结局没有差异，支持使用快速反应系统来识别病情恶化的病房患者。
