重症监护病房(ICU)转出时的国家早期预警评分(NEWS)可预测 ICU 转出后的早期临床恶化。
National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer.
机构信息
Medical Intensive Care Unit, Songklanagarind Hospital, Hat Yai, Songkhla 90110, Thailand.
Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
出版信息
J Crit Care. 2018 Feb;43:225-229. doi: 10.1016/j.jcrc.2017.09.008. Epub 2017 Sep 13.
OBJECTIVE
This study aims to determine the ability of the National Early Warning Score at ICU discharge (NEWS) to predict the development of clinical deterioration within 24h.
METHODS
A prospective observational study was conducted. The NEWS was immediately recorded before discharge (NEWS). The development of early clinical deterioration was defined as acute respiratory failure or circulatory shock within 24h of ICU discharge. The discrimination of NEWS and the best cut off value of NEWS to predict the early clinical deterioration was determined.
RESULTS
Data were collected from 440 patients. The incidence of early clinical deterioration after ICU discharge was 14.8%. NEWS was an independent predictor for early clinical deterioration after ICU discharge (OR 2.54; 95% CI 1.98-3.26; P<0.001). The AUROC of NEWS was 0.92±0.01 (95% CI 0.89-0.94, P<0.001). A NEWS>7 showed a sensitivity of 93.6% and a specificity of 82.2% to detect an early clinical deterioration after ICU discharge.
CONCLUSION
Among critically ill patients who were discharged from ICU, a NEWS>7 showed the best sensitivity and specificity to detect early clinical deterioration 24h after ICU discharge.
目的
本研究旨在确定 ICU 出院时的国家早期预警评分(NEWS)预测 24 小时内临床恶化的能力。
方法
进行了一项前瞻性观察研究。NEWS 在出院前立即记录(NEWS)。早期临床恶化的发展定义为 ICU 出院后 24 小时内发生急性呼吸衰竭或循环休克。确定了 NEWS 的区分度和预测早期临床恶化的最佳 NEWS 截断值。
结果
共收集了 440 例患者的数据。ICU 出院后早期临床恶化的发生率为 14.8%。NEWS 是 ICU 出院后早期临床恶化的独立预测因素(OR 2.54;95%CI 1.98-3.26;P<0.001)。NEWS 的 AUROC 为 0.92±0.01(95%CI 0.89-0.94,P<0.001)。NEWS>7 预测 ICU 出院后 24 小时内发生早期临床恶化的敏感性为 93.6%,特异性为 82.2%。
结论
在从 ICU 出院的危重病患者中,NEWS>7 显示出最佳的敏感性和特异性,可检测出 ICU 出院后 24 小时内的早期临床恶化。