Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
Crit Care Resusc. 2014 Jun;16(2):119-26.
To compare the admission characteristics, discharge destination and mortality of patients reviewed by the rapid response team (RRT) for deterioration with those of other hospital patients; and to determine the association between RRT review for deterioration and mortality.
DESIGN, SETTING AND PATIENTS: Acute admissions of adult patients to a tertiary hospital between 1 January 2008 and 31 December 2011 were identified from administrative data. Data for each patient's first admission were merged with RRT data on the first RRT event of each admission, if any. RRT events involving cardiac arrest were classified as arrest events and all others as deterioration events.
Of 43 385 patients in the cohort, 1117 (2.57%) had RRT review for deterioration and 91 (0.21%) for cardiac arrest. Deterioration events occurred a median of 3.23 days after admission. Advanced treatments were instituted in 38.59% of deterioration events, and a new not-for resuscitation order for 5.55%. Compared with those not reviewed by the RRT, patients in the deterioration group were older (median, 70 v 60 years, P < 0.001) and had a higher Charlson comorbidity index (median, 1 v 0, P < 0.001). They also more often died in hospital (18.80% v 1.42%, P < 0.001) or were discharged to another hospital (37.51% v 13.39%, P < 0.001) and more often died in the 90 days after admission (24.44% v 3.48%, P < 0.001). Their adjusted odds ratio of death in the 90 days after admission was 5.85 (95% CI, 4.97-6.89, P < 0.001).
Patients reviewed for deterioration were older and had greater comorbidity than patients the RRT was not called to review. RRT review for deterioration was an independent risk factor for mortality.
比较因病情恶化而接受快速反应团队（RRT）评估的患者与其他住院患者的入院特征、出院去向和死亡率；并确定 RRT 因病情恶化进行评估与死亡率之间的关联。
设计、地点和患者：从行政数据中确定 2008 年 1 月 1 日至 2011 年 12 月 31 日期间三级医院的成年患者急性入院情况。合并了每位患者首次入院的资料，以及如果存在的话，每位入院患者首次 RRT 事件的 RRT 数据。涉及心搏骤停的 RRT 事件被归类为心搏骤停事件，其他所有事件均归类为病情恶化事件。
在队列中的 43385 例患者中，有 1117 例（2.57%）因病情恶化而接受 RRT 评估，91 例（0.21%）因心搏骤停而接受评估。病情恶化事件发生在入院后中位 3.23 天。在 38.59%的病情恶化事件中采取了高级治疗措施，5.55%的新非复苏医嘱。与未接受 RRT 评估的患者相比，恶化组患者年龄更大（中位数为 70 岁比 60 岁，P < 0.001），Charlson 合并症指数更高（中位数为 1 比 0，P < 0.001）。他们在医院内的死亡率也更高（18.80%比 1.42%，P < 0.001）或出院至其他医院（37.51%比 13.39%，P < 0.001），入院后 90 天的死亡率也更高（24.44%比 3.48%，P < 0.001）。他们在入院后 90 天的死亡调整比值比为 5.85（95%CI，4.97-6.89，P < 0.001）。
接受 RRT 因病情恶化进行评估的患者比未被 RRT 呼叫进行评估的患者年龄更大，合并症更多。RRT 因病情恶化进行评估是死亡率的独立危险因素。
