Skitch Steven, Tam Benjamin, Xu Michael, McInnis Laura, Vu Anthony, Fox-Robichaud Alison
*Division of Emergency Medicine,McMaster University,Hamilton General Hospital,Hamilton,ON.
†Division of Critical Care,McMaster University,Hamilton General Hospital,Hamilton,ON.
CJEM. 2018 Mar;20(2):266-274. doi: 10.1017/cem.2017.21. Epub 2017 May 10.
Early warning scores use vital signs to identify patients at risk of critical illness. The current study examines the Hamilton Early Warning Score (HEWS) at emergency department (ED) triage among patients who experienced a critical event during their hospitalization. HEWS was also evaluated as a predictor of sepsis.
The study population included admissions to two hospitals over a 6-month period. Cases experienced a critical event defined by unplanned intensive care unit admission, cardiopulmonary resuscitation, or death. Controls were randomly selected from the database in a 2-to-1 ratio to match cases on the burden of comorbid illness. Receiver operating characteristic (ROC) curves were used to evaluate HEWS as a predictor of the likelihood of critical deterioration and sepsis.
The sample included 845 patients, of whom 270 experienced a critical event; 89 patients were excluded because of missing vitals. An ROC analysis indicated that HEWS at ED triage had poor discriminative ability for predicting the likelihood of experiencing a critical event 0.62 (95% CI 0.58-0.66). HEWS had a fair discriminative ability for meeting criteria for sepsis 0.77 (95% CI 0.72-0.82) and good discriminative ability for predicting the occurrence of a critical event among septic patients 0.82 (95% CI 0.75-0.90).
This study indicates that HEWS at ED triage has limited utility for identifying patients at risk of experiencing a critical event. However, HEWS may allow earlier identification of septic patients. Prospective studies are needed to further delineate the utility of the HEWS to identify septic patients in the ED.
早期预警评分利用生命体征来识别有危重症风险的患者。本研究在住院期间经历危急事件的患者中，对急诊科（ED）分诊时的汉密尔顿早期预警评分（HEWS）进行了研究。HEWS也被评估为脓毒症的预测指标。
研究人群包括两家医院6个月期间的入院患者。病例组为经历了由非计划入住重症监护病房、心肺复苏或死亡所定义的危急事件的患者。对照组以2:1的比例从数据库中随机选取，以匹配病例组患者的合并症负担。采用受试者工作特征（ROC）曲线来评估HEWS作为危急病情恶化和脓毒症可能性预测指标的性能。
样本包括845例患者，其中270例经历了危急事件；89例因生命体征数据缺失而被排除。ROC分析表明，ED分诊时的HEWS对预测经历危急事件可能性的判别能力较差，曲线下面积为0.62（95%可信区间0.58 - 0.66）。HEWS对符合脓毒症标准的判别能力中等，曲线下面积为0.77（95%可信区间0.72 - 0.82），对预测脓毒症患者中危急事件发生的判别能力良好，曲线下面积为0.82（95%可信区间0.75 - 0.90）。
本研究表明，ED分诊时的HEWS在识别有危急事件风险的患者方面效用有限。然而，HEWS可能有助于更早识别脓毒症患者。需要进行前瞻性研究以进一步明确HEWS在ED中识别脓毒症患者的效用。
