de Grooth Harm-Jan, Girbes Armand R, Loer Stephan A
Department of Anesthesiology, Amsterdam University Medical Centers, Location VUmc, Amsterdam.
Department of Anesthesiology, Zaans Medisch Centrum, Zaandam.
Curr Opin Anaesthesiol. 2018 Dec;31(6):732-738. doi: 10.1097/ACO.0000000000000657.
Early warnings scores are designed to detect clinical deterioration and promote intervention at the earliest possible moment. Although the ultimate effects on patient outcomes are unclear, early warning scores are now legally mandated in several countries. Here, we review the performance of early warning scores in surgical and perioperative populations.
Early warning scores can be used to screen for postoperative deterioration and surgical complications. We describe a framework to evaluate the balance between missed events and warning signals that are not followed by an adverse event (nonevents). In large surgical cohort studies, the missed event rates ranged between 19 and 69% and the nonevent rates ranged between 72 and 99% for 'optimal' threshold early warning sores. Recent investigations have shown that there may be a substantial discrepancy between the theoretical benefits shown in validation studies and the practical clinical implementation of early warning scores, which may partly explain the absence of measurable benefit from these systems.
Early warning scores may facilitate protocolized escalation of care for patients at risk of adverse events and can be used in surgical and postoperative patients, but high nonevent rates and practical implementation problems can restrict their usefulness.
早期预警评分旨在检测临床病情恶化，并尽早促进干预措施的实施。尽管对患者预后的最终影响尚不清楚，但目前在几个国家，早期预警评分已成为法律规定的要求。在此，我们综述早期预警评分在外科及围手术期人群中的表现。
早期预警评分可用于筛查术后病情恶化及手术并发症。我们描述了一个框架，用于评估漏诊事件与未引发不良事件（假警报）的预警信号之间的平衡。在大型外科队列研究中，对于“最佳”阈值早期预警评分，漏诊事件率在19%至69%之间，假警报率在72%至99%之间。近期研究表明，验证研究中显示的理论益处与早期预警评分在实际临床应用中可能存在显著差异，这可能部分解释了这些系统为何缺乏可衡量的益处。
早期预警评分可能有助于对有不良事件风险的患者进行规范化的护理升级，可用于外科手术及术后患者，但高假警报率和实际应用问题可能会限制其效用。
