儿科医疗急救团队与医院死亡率的关联。
Association of Pediatric Medical Emergency Teams With Hospital Mortality.
机构信息
Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, and Creighton University (S.K.).
Division of Cardiology, Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital of Omaha (Q.K., N.J.).
出版信息
Circulation. 2018 Jan 2;137(1):38-46. doi: 10.1161/CIRCULATIONAHA.117.029535. Epub 2017 Oct 4.
BACKGROUND
Implementation of medical emergency teams has been identified as a potential strategy to reduce hospital deaths, because these teams respond to patients with acute physiological decline in an effort to prevent in-hospital cardiac arrest. However, prior studies of the association between medical emergency teams and hospital mortality have been limited and typically have not accounted for preimplementation mortality trends.
METHODS
Within the Pediatric Health Information System for freestanding pediatric hospitals, annual risk-adjusted mortality rates were calculated for sites between 2000 and 2015. A random slopes interrupted time series analysis then examined whether implementation of a medical emergency team was associated with lower-than-expected mortality rates based on preimplementation trends.
RESULTS
Across 38 pediatric hospitals, mean annual hospital admission volume was 15 854 (range, 6684-33 024), and there were a total of 1 659 059 hospitalizations preimplementation and 4 392 392 hospitalizations postimplementation. Before medical emergency team implementation, hospital mortality decreased by 6.0% annually (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.92-0.96) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6% annually (OR, 0.94; 95% CI, 0.93-0.95), with no deepening of the mortality slope (ie, not lower OR) in comparison with the preimplementation trend, for the overall cohort (=0.98) or when analyzed separately within each of the 38 study hospitals. Five years after medical emergency team implementation across study sites, there was no difference between predicted (hospital mean of 6.18 deaths per 1000 admissions based on preimplementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; =0.57).
CONCLUSIONS
Implementation of medical emergency teams in a large sample of pediatric hospitals in the United States was not associated with a reduction in hospital mortality beyond existing preimplementation trends.
背景
实施医疗急救团队已被确定为降低医院死亡率的潜在策略，因为这些团队会对急性生理下降的患者做出反应，以防止院内心脏骤停。然而，先前关于医疗急救团队与医院死亡率之间的关联的研究受到限制，并且通常没有考虑到实施前的死亡率趋势。
方法
在独立儿科医院的儿科健康信息系统中，计算了 2000 年至 2015 年期间各站点的年度风险调整死亡率。然后，采用随机斜率中断时间序列分析来检查实施医疗急救团队是否与根据实施前趋势预测的较低死亡率相关。
结果
在 38 家儿科医院中，平均每年医院入院量为 15854 例（范围为 6684-33024 例），实施前共有 1659059 例住院治疗，实施后共有 4392392 例住院治疗。在实施医疗急救团队之前，所有医院的医院死亡率每年下降 6.0%（比值比 [OR]，0.94；95%置信区间 [CI]，0.92-0.96）。实施医疗急救团队后，医院死亡率继续每年下降 6%（OR，0.94；95%CI，0.93-0.95），与实施前的趋势相比，死亡率斜率没有加深（即 OR 没有更低），对于整个队列（=0.98）或在 38 家研究医院中的每一家单独分析时都是如此。在研究地点实施医疗急救团队五年后，预测死亡率（基于实施前趋势，每 1000 例入院死亡 6.18 例）与实际死亡率（每 1000 例入院死亡 6.48 例）之间没有差异（=0.57）。
结论
在美国的一个大型儿科医院样本中实施医疗急救团队并不能降低死亡率，而超过现有实施前的趋势。
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