Tirkkonen J, Kontula T, Hoppu S
Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland.
Department of Anaesthesiology and Intensive Care Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Acta Anaesthesiol Scand. 2017 Nov;61(10):1278-1285. doi: 10.1111/aas.12993. Epub 2017 Sep 15.
Rapid response teams (RRTs) triage most patients to stay on ward, even though some of them have deranged vital signs according to RRTs themselves. We investigated the prevalence and outcome of this RRT patient cohort.
A prospective observational study was conducted in a Finnish tertiary referral centre, Tampere University Hospital. Data on RRT activations were collected between 1 May 2012 and 30 April 2015. Vital signs of patients triaged to stay on ward without treatment limitations were classified according to objective RRT trigger criteria observed during the reviews.
During the study period, 860 patients had their first RRT review and were triaged to stay on ward. Of these, 564 (66%) had deranged vital signs, while 296 (34%) did not. RRT patients with deranged vital signs were of comparable age and comorbidity index as stable patients. Even though the patients with deranged vital signs had received RRT interventions, such as fluids and medications, more often than the stable patients, they required new RRT reviews more often and had higher in-hospital and 30-day mortality. Moreover, the former group had substantially higher 1-year mortality than the latter (37% vs. 29%, P = 0.014). In a multivariate regression analysis, deranged vital signs during RRT review was found to be independently associated with 30-day mortality (OR 1.74; 95% CI 1.12-2.70).
Patients triaged to stay on ward despite deranged vital signs are high-risk patients who could benefit from routine follow-up by RRT nurses before they deteriorate beyond salvation.
快速反应团队（RRTs）将大多数患者分诊至病房留观，尽管其中一些患者根据RRTs自身的判断存在生命体征紊乱。我们调查了这一RRT患者队列的患病率及转归情况。
在芬兰三级转诊中心坦佩雷大学医院进行了一项前瞻性观察研究。收集了2012年5月1日至2015年4月30日期间RRT启动的数据。根据复查时观察到的客观RRT触发标准，对分诊至病房留观且无治疗限制的患者的生命体征进行分类。
在研究期间，860例患者接受了首次RRT复查并被分诊至病房留观。其中，564例（66%）存在生命体征紊乱，而296例（34%）没有。生命体征紊乱的RRT患者与病情稳定的患者在年龄和合并症指数方面具有可比性。尽管生命体征紊乱的患者比病情稳定的患者更频繁地接受了RRT干预，如补液和用药，但他们更频繁地需要新的RRT复查，且住院期间及30天死亡率更高。此外，前一组的1年死亡率显著高于后一组（37%对29%，P = 0.014）。在多因素回归分析中，发现RRT复查时生命体征紊乱与30天死亡率独立相关（比值比1.74；95%置信区间1.12 - 2.70）。
尽管生命体征紊乱但仍被分诊至病房留观的患者是高危患者，他们可能会从RRT护士在病情恶化到无法挽救之前进行的常规随访中获益。
