Kayambankadzanja Raphael Kazidule, Schell Carl Otto, Nsanjama Grace, Mbingwani Isaac, Kwazizira Mndolo Samson, Rylance Jamie, Baker Tim
University of Malawi, College of Medicine, Blantyre, Malawi.
Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Emerg Med Int. 2019 Jul 7;2019:6586891. doi: 10.1155/2019/6586891. eCollection 2019.
Vital signs are often used in triage, but some may be difficult to assess in low-resource settings. A patient's ability to walk is a simple and rapid sign that requires no equipment or expertise. This study aimed to determine the predictive performance for death of an inability to walk among hospitalized Malawian adults and to compare its predictive value with the vital signs-based National Early Warning Score (NEWS).
It is a prospective cohort study of adult in-patients on selected days in two hospitals in Malawi. Patients were asked to walk five steps with close observation and their vital signs were assessed. Sensitivities, specificities, and predictive values for in-patient death of an inability to walk were calculated and an inability to walk was compared with NEWS.
Four-hundred and forty-three of the 1094 participants (40.5%) were unable to walk independently. In this group, 70 (15.8 %) died in-hospital compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p<0.001). Inability to walk had a sensitivity for death of 81.4%, specificity of 63.0%, positive predictive value (PPV) of 15.8%, and negative predictive value (NPV) of 97.5%. NEWS>6 had sensitivity 70.9%, specificity 70.6%, PPV 17.1%, and NPV 96.6%. An inability to walk had a fair concordance with NEWS>6 (kappa 0.21).
Inability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of death. Walking ability could be considered an additional vital sign and may be useful for triage.
生命体征常用于分诊，但在资源匮乏的环境中，有些生命体征可能难以评估。患者的行走能力是一个简单快速的体征，无需设备或专业知识。本研究旨在确定马拉维住院成年人中无法行走对死亡的预测性能，并将其预测价值与基于生命体征的国家早期预警评分（NEWS）进行比较。
这是一项对马拉维两家医院特定日期成年住院患者的前瞻性队列研究。要求患者在密切观察下走五步，并评估其生命体征。计算无法行走对住院患者死亡的敏感性、特异性和预测值，并将无法行走与NEWS进行比较。
1094名参与者中有443人（40.5%）无法独立行走。在这组中，70人（15.8%）在医院死亡，而能够行走的患者中有16人（2.5%）死亡：比值比为7.4（95%可信区间4.3 - 13.0，p<0.001）。无法行走对死亡的敏感性为81.4%，特异性为63.0%，阳性预测值（PPV）为15.8%，阴性预测值（NPV）为97.5%。NEWS>6时，敏感性为70.9%，特异性为70.6%，PPV为17.1%，NPV为96.6%。无法行走与NEWS>6有一定的一致性（kappa值为0.21）。
在马拉维住院成年人中，无法行走对死亡率的预测效果与NEWS相当。能够行走的患者死亡风险较低。行走能力可被视为一项额外的生命体征，可能有助于分诊。
