Roberts Daniel, Djärv Therese
Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Am J Emerg Med. 2017 Nov;35(11):1601-1606. doi: 10.1016/j.ajem.2017.04.072. Epub 2017 Apr 28.
In-hospital cardiac arrests (IHCAs) are often preceded by abnormal vital signs. Preceding abnormal vital signs might lower the physiological reserve capacity and therefore decrease survival after an IHCA.
To assess the preceding national early warning score (NEWS) and its relation to survival after an IHCA.
All patients ≥18years suffering an IHCA at Karolinska University Hospital between 1st January 2014 and 31st December 2015 were included. Data regarding the IHCA, patient characteristics, calculated NEWS and 30-day survival were obtained from electronic patient records. Parameters included in NEWSs were assessed up to 12h before the IHCA. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with NEWSs of 0-4 points (low) versus those with at least 5 points (moderate) and 7 points (high). Adjustments included hospital site, sex, co-morbidities, first rhythm and location of the IHCA.
In all, 358 patients suffered an IHCA, of whom 109 (30%) survived at least 30days and 296 (83%) had sufficient vital sign documentation to calculate NEWS before the IHCA. The 87 patients with a medium NEWS had a fourfold chance and those 78 with a high NEWS (22%) had an almost tenfold chance of dying after the IHCA compared to those with a low NEWS (Adjusted OR 4.43, 95% CI 1.81-10.83 and OR 9.88 95% C.I. 2.77-35.26, respectively).
The NEWS can be a probable proxy for estimating physiological reserve capacity since high NEWS is associated to high change of death in case of an IHCA. This information can be used when discussing prognosis with patients and relatives. But even more importantly, it stresses the need for better preventive strategies in IHCAs. STRENGTHENS AND LIMITATIONS WITH THIS STUDY.
院内心脏骤停（IHCA）之前常伴有生命体征异常。之前的生命体征异常可能会降低生理储备能力，从而降低院内心脏骤停后的生存率。
评估之前的国家早期预警评分（NEWS）及其与院内心脏骤停后生存率的关系。
纳入2014年1月1日至2015年12月31日在卡罗林斯卡大学医院发生院内心脏骤停的所有≥18岁患者。有关院内心脏骤停、患者特征、计算出的NEWS和30天生存率的数据从电子病历中获取。在院内心脏骤停前长达12小时评估NEWS中包含的参数。使用调整后的逻辑回归模型评估生存率差异，并以0至4分（低）与至少5分（中度）和7分（高）的患者之间的优势比和95%置信区间（OR，95%CI）表示。调整因素包括医院地点、性别、合并症、首次心律和院内心脏骤停的位置。
共有358例患者发生院内心脏骤停，其中109例（30%）存活至少30天，296例（83%）有足够的生命体征记录以在院内心脏骤停前计算NEWS。与低NEWS患者相比，87例中度NEWS患者院内心脏骤停后死亡几率增加四倍，78例高NEWS患者（22%）死亡几率增加近十倍（调整后的OR分别为4.43，95%CI 1.81 - 10.83和OR 9.88，95%CI 2.77 - 35.26）。
由于高NEWS与院内心脏骤停时的高死亡几率相关，NEWS可能是估计生理储备能力的一个指标。在与患者及家属讨论预后时可使用此信息。但更重要的是，它强调了对院内心脏骤停采取更好预防策略的必要性。本研究的优势与局限性。
