对预定义的快速反应小组呼叫标准的修改：患病率、特征及相关结果。

Modifications to predefined rapid response team calling criteria: prevalence, characteristics and associated outcomes.

作者信息

Ganju Anamika, Kapitola Karoline, Chalwin Richard

机构信息

Intensive Care Unit, Prince Charles Hospital, Brisbane, QLD, Australia.

Rapid Response System, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.

出版信息

Crit Care Resusc. 2019 Mar;21(1):32-38.

PMID:30857510

Abstract

OBJECTIVE

Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes.

DESIGN AND OUTCOME MEASURES

A pilot retrospective cohort study within a convenience sample of patients attended by a hospital RRT between July and December 2014; rates of repeat RRT calling and in-hospital mortality were compared between patients with and without modifications to standard calling criteria. Secondary analyses examined four different types of modifications, narrowing or widening of existing physiological calling criteria, to observations without defined calling criteria, and others. All analyses were performed using multivariable regression.

RESULTS

During the study period, 673 patients had RRT calls, of whom 620 (91.2%) had data available for analysis. The majority of study patients (393; 63.4%) had modifications documented. Patients with modifications were more likely to have repeat RRT calls (odds ratio [OR], 2.86; 95% CI, 1.69-4.85) and experience in-hospital mortality (OR, 2.16; 95% CI, 1.31-3.57) versus patients without modifications. In the secondary analyses, although all classes of modification had higher rates of repeat calling, none reached statistical significance. Mortality was associated with having modifications that were more conservative than the standard calling criteria (adjusted OR, 2.81; 95% CI, 1.31-6.08).

CONCLUSION

Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.

摘要

目的

标准化快速反应团队（RRT）的呼叫标准可能并非适用于所有患者，因此，对这些标准进行调整或许是合理的，以防止不必要的呼叫。关于调整RRT呼叫标准的有效性或安全性的可用数据很少；因此，本研究旨在详细说明RRT呼叫触发因素调整的发生率和特征，并探讨它们与患者结局的关系。

设计与结局指标

在2014年7月至12月期间，对一家医院RRT接诊的便利样本患者进行一项试点回顾性队列研究；比较了标准呼叫标准有无调整的患者之间重复RRT呼叫率和院内死亡率。二次分析检查了四种不同类型的调整，即现有生理呼叫标准的缩小或扩大、对无明确呼叫标准的观察结果的调整以及其他调整。所有分析均使用多变量回归进行。

结果

在研究期间，673例患者进行了RRT呼叫，其中620例（91.2%）有可供分析的数据。大多数研究患者（393例；63.4%）有调整记录。与未调整的患者相比，调整后的患者更有可能进行重复RRT呼叫（优势比[OR]，2.86；95%CI，1.69 - 4.85）和发生院内死亡（OR，2.16；95%CI，1.31 - 3.57）。在二次分析中，尽管所有类型的调整重复呼叫率都较高，但均未达到统计学显著性。死亡率与比标准呼叫标准更保守的调整有关（调整后OR，2.81；95%CI，1.31 - 6.08）。