Joshi K, Campbell V, Landy M, Anstey C M, Gooch R
Registrar, Department of Anaesthesia, Rockhampton Base Hospital, Rockhampton, Queensland.
Consultant, Intensive Care Unit, Nambour General Hospital, Nambour, Queensland.
Anaesth Intensive Care. 2017 May;45(3):369-374. doi: 10.1177/0310057X1704500313.
Hospital systems for the recognition (afferent limb) and management (efferent limb) of deteriorating patients, or Rapid Response Systems (RRSs), are being mandated worldwide, in spite of conflicting evidence regarding their efficacy. We have evaluated the impact of an Adult Deterioration Detection System (Q-ADDS)-based RRS specifically on illness severity at intensive care unit (ICU) admission and ICU length of stay (LOS), as well as previously studied endpoints. We undertook a retrospective, single-centre observational study comparing equivalent 18-month periods before the Q-ADDS-based RRS, and after implementation. The primary endpoints of the study were illness severity of unplanned ICU admissions from the ward, ICU length of stay, and ICU mortality. Secondary endpoints were RRS call numbers, rate of unplanned ICU admissions, and ward-based cardiorespiratory arrests. Following the introduction of the new RRS, Acute Pain and Chronic Health Evaluation (APACHE) II (17 versus 21, <0.001), APACHE III (64 versus 68, =0.011) and Simplified Acute Physiology Score (35 versus 38, =0.044) scores at ICU admission from the ward were reduced. Fewer patients were in the >50% predicted mortality range of APACHE II (16% versus 32%, <0.001), APACHE III (18% versus 28%, =0.012) and Simplified Acute Physiology Score (14% versus 24%, =0.006). ICU mortality was unchanged (13.7% versus 13.8%, =0.93). ICU LOS was reduced (3 versus 4 days, =0.02); prolonged stay (>7 days) was not significantly changed (19% versus 27%, =0.055). Unplanned ICU admissions, cardiorespiratory arrests and hospital mortality were unchanged. The frequency of RRS activation (48 versus 11 per 1,000 admissions, <0.001) was markedly increased. This Q-ADDS form-based RRS has resulted in lower illness severity at ICU admission from the ward, and fewer patients with scores associated with a >50% predicted mortality. Overall, ICU length of stay was reduced. These specific outcomes may reliably reflect RRS efficacy, even in smaller centres.
尽管关于快速反应系统（RRSs）疗效的证据存在矛盾，但全球仍在强制推行用于识别（传入环节）和管理（传出环节）病情恶化患者的医院系统，即快速反应系统。我们评估了基于成人病情恶化检测系统（Q-ADDS）的RRS对重症监护病房（ICU）入院时疾病严重程度、ICU住院时间（LOS）以及先前研究的终点指标的影响。我们进行了一项回顾性单中心观察性研究，比较了基于Q-ADDS的RRS实施前后相等的18个月时间段。该研究的主要终点指标是病房非计划入住ICU患者的疾病严重程度、ICU住院时间和ICU死亡率。次要终点指标是RRS呼叫次数、非计划入住ICU的发生率以及病房内的心搏呼吸骤停情况。引入新的RRS后，病房患者入住ICU时的急性生理与慢性健康状况评分系统（APACHE）II（17比21，<0.001）、APACHE III（64比68，=0.011）和简化急性生理学评分（35比38，=0.044）得分降低。处于APACHE II预测死亡率>50%范围的患者减少（16%比32%，<0.001），APACHE III（18%比28% =0.012）和简化急性生理学评分（14%比24% =0.006）。ICU死亡率未变（13.7%比13.8%，=0.93）。ICU住院时间缩短（3天比4天 =0.02）；延长住院时间（>7天）无显著变化（19%比27%，=0.055）。非计划入住ICU、心搏呼吸骤停和医院死亡率未变，但RRS激活频率显著增加（每1000例入院患者中48次比11次，<0.001）。这种基于Q-ADDS表格的RRS使病房患者入住ICU时疾病严重程度降低，且预测死亡率>50%的评分患者减少。总体而言ICU住院时间缩短。即使在较小的中心，这些特定结果也可能可靠地反映RRS的疗效。
