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入院后第二天的客观观察或患者的主观感受变化是否是院内死亡率的最佳预测指标?撒哈拉以南资源匮乏地区一家医院的观察性研究。

Are changes in objective observations or the patient's subjective feelings the day after admission the best predictors of in-hospital mortality? An observational study in a low-resource sub-Saharan hospital.

机构信息

Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

Kitovu Hospital, Masaka, Uganda.

出版信息

Resuscitation. 2019 Feb;135:130-136. doi: 10.1016/j.resuscitation.2018.10.023. Epub 2018 Oct 26.

Abstract

BACKGROUND

The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified.

AIM

Compare changes the day after admission in the patient's subjective feelings and objective findings that included age, gender, the National Early Warning Score (NEWS) on admission, gait stability and mid-upper arm circumference (MUAC) on admission, and changes in NEWS, gait stability and mental alertness.

SETTING

Acutely ill medical patients admitted to a low-resource sub-Saharan hospital.

METHODS

Prospective observational study.

RESULTS

1810 patients were reassessed 18 h after hospital admission. Logistic regression identified NEWS and gait stability on admission, a subjective feeling of improvement, the change in NEWS, and MUAC as clinically significant predictors of in-hospital mortality. Stratifying patients according to their NEWS on admission altered the predictive value of the four other predictors: for patients with an admission NEWS < 3 a subjective feeling of improvement is the most powerful predictor of a good outcome. For patients with an admission NEWS > = 3 the change in NEWS, gait stability on admission and MUAC provide additional prognostic information.

CONCLUSION

NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.

摘要

背景

住院后首次临床再评估可能提供了最佳机会,以发现临床恶化或改善失败,并决定是否应加强治疗。

目的

比较入院后第 1 天患者主观感觉和客观发现的变化,包括年龄、性别、入院时的国家早期预警评分(NEWS)、入院时的步态稳定性和上臂中部周长(MUAC)以及 NEWS、步态稳定性和精神警觉性的变化。

设置

在资源匮乏的撒哈拉以南非洲的一家低资源医院收治的急性病患者。

方法

前瞻性观察性研究。

结果

共有 1810 例患者在入院后 18 小时接受了重新评估。逻辑回归确定了入院时的 NEWS 和步态稳定性、主观感觉改善、NEWS 的变化以及 MUAC 是院内死亡率的临床显著预测指标。根据入院时的 NEWS 对患者进行分层改变了其他四个预测指标的预测价值:对于入院时 NEWS<3 的患者,主观感觉改善是良好结局的最有力预测指标。对于入院时 NEWS≥3 的患者,入院时的 NEWS、步态稳定性和 MUAC 的变化提供了额外的预后信息。

结论

入院时的 NEWS 和步态稳定性、MUAC、主观感觉改善以及入院后第 1 天的 NEWS 变化均是院内死亡率的临床显著预测指标。

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