Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue - Room D108, Toronto, ON, M4N 3M5, Canada.
Can J Anaesth. 2018 Nov;65(11):1210-1217. doi: 10.1007/s12630-018-1180-5. Epub 2018 Jul 6.
Early warning scores (EWS) and critical care outreach teams (CCOT) have been developed to respond to decompensating patients. Nevertheless, controversy exists around their effectiveness. The primary objective of this study was to determine if a delay of ≥ 60 min between when a patient was identified as meeting EWS criteria and the CCOT was activated impacted in-hospital mortality.
This was a historical cohort study evaluating all new CCOT activations over a four-year study period (1 June 2007 to 31 August 2011) for inpatients ≥ 18 yr of age at two academic tertiary care hospitals in London, Ontario, Canada. Multivariable logistic regression accounting for repeated measures was used to determine the effect of delayed CCOT activation on in-hospital mortality (primary outcome). Differences in outcomes between medical and surgical patients were also examined.
There were 3,133 CCOT activations for 1,684 (53.8%) medical patients and 1,449 (46.2%) surgical patients during the study period. The CCOT was activated < 60 min of a patient meeting EWS criteria in 2,160 (68.9%) cases and ≥ 60 min in 973 (31.1%) cases. Patients with ≥ 60 min delay were more likely be admitted to the intensive care unit (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.07 to 1.47) and to suffer in-hospital mortality (OR, 1.30; 95% CI, 1.08 to 1.56). Irrespective of delay, surgical patients were less likely to experience in-hospital mortality than medical patients (OR, 0.46; 95% CI, 0.39 to 0.55).
Including the rates of delay in CCOT activation and the admitting service could be an additional step in exploring the conflicting results seen in the current literature assessing the impact of CCOT on patient outcomes.
预警评分（EWS）和重症监护外展团队（CCOT）的开发是为了应对病情恶化的患者。然而，它们的有效性仍存在争议。本研究的主要目的是确定患者被确定符合 EWS 标准与 CCOT 激活之间的延迟时间是否≥60 分钟会影响住院死亡率。
这是一项在加拿大安大略省伦敦的两家学术型三级保健医院进行的为期四年的回顾性队列研究（2007 年 6 月 1 日至 2011 年 8 月 31 日），评估所有新的 CCOT 激活情况。多变量逻辑回归考虑了重复测量，以确定 CCOT 激活延迟对住院死亡率（主要结局）的影响。还检查了内科和外科患者之间的结果差异。
在研究期间，有 3133 次 CCOT 激活，其中 1684 例（53.8%）为内科患者，1449 例（46.2%）为外科患者。当患者符合 EWS 标准时，CCOT 在 60 分钟内激活的有 2160 例（68.9%），60 分钟以上激活的有 973 例（31.1%）。延迟时间≥60 分钟的患者更有可能被收入重症监护病房（比值比[OR]，1.22；95%置信区间[CI]，1.07 至 1.47），且更有可能发生院内死亡（OR，1.30；95% CI，1.08 至 1.56）。无论有无延迟，外科患者的院内死亡率均低于内科患者（OR，0.46；95% CI，0.39 至 0.55）。
纳入 CCOT 激活延迟的发生率和收治科室可能是评估 CCOT 对患者结局影响的现有文献中出现冲突结果的一个额外步骤。
