Huggan P J, Akram F, Er B H D, Christen L S J, Weixian L, Lim V, Huang Y, Merchant R A
Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
University Medicine Cluster, National University Health System, Singapore.
Intern Med J. 2015 Jul;45(7):732-40. doi: 10.1111/imj.12795.
Simple measures of acute physiologic compromise, functional status and comorbidity may help clinicians to make decisions relating to clinical care and resource utilisation.
To explore the usefulness of common assessment tools in predicting outcomes of (i) death or intensive care unit (ICU) admission and (ii) length of hospital stay at a busy tertiary hospital in Singapore.
Three hundred and ninety-eight consecutive admissions to two general medicine teams were prospectively assessed during 2 months in 2011. Patients were followed until discharge or transfer to ICU/high dependency unit (HDU). Data collected included routine demographic data, final diagnosis, comorbid conditions including a weighted prognostic comorbidity index (the updated Charlson index) and the modified Early Warning Score (MEWS) at presentation to the emergency department. The admission modified Barthel Index was recorded for patients aged 65 and over. Death and total length of hospital stay were recorded in all cases.
Of 398 patients, 16 (4 %) died or were transferred to ICU and 99 (25%) stayed for more than 7 days. Medical early warning (MEW) scores of ≥5 were significantly associated with death or ICU admission (hazard ratio 5.50, 95% confidence interval 1.77-17.07, P = 0.003). There was no independent association between this outcome and the Charlson score or admission Barthel Index. Excess length of stay was associated with a modified Barthel Index ≤17 and altered mental status at presentation.
Among unselected general medical patients, MEW scores of ≥5 were significantly associated with death or ICU admissions and only functional status and altered mental status were independent predictors of excess length of stay.
急性生理功能损害、功能状态和合并症的简单评估指标可能有助于临床医生做出有关临床护理和资源利用的决策。
探讨常用评估工具在预测新加坡一家繁忙的三级医院患者（i）死亡或入住重症监护病房（ICU）以及（ii）住院时间方面的有用性。
2011年，在两个月内对两个普通内科团队连续收治的398例患者进行前瞻性评估。对患者进行随访，直至出院或转至ICU/高依赖病房（HDU）。收集的数据包括常规人口统计学数据、最终诊断、合并症情况，包括加权预后合并症指数（更新后的Charlson指数）以及急诊科就诊时的改良早期预警评分（MEWS）。记录65岁及以上患者入院时的改良Barthel指数。记录所有病例的死亡情况和总住院时间。
398例患者中，16例（4%）死亡或转至ICU，99例（25%）住院时间超过7天。MEW评分≥5与死亡或入住ICU显著相关（风险比5.50，95%置信区间1.77 - 17.07，P = 0.003）。该结果与Charlson评分或入院时的Barthel指数无独立相关性。住院时间过长与改良Barthel指数≤17以及就诊时精神状态改变有关。
在未经选择的普通内科患者中，MEW评分≥5与死亡或入住ICU显著相关，只有功能状态和精神状态改变是住院时间过长的独立预测因素。
