Lindskou Tim Alex, Lübcke Kenneth, Kløjgaard Torben Anders, Laursen Birgitte Schantz, Mikkelsen Søren, Weinreich Ulla Møller, Christensen Erika Frischknecht
Department of Clinical Medicine Centre for Prehospital and Emergency Research Aalborg University Aalborg Denmark.
Emergency Medical Services North Denmark Region Aalborg Denmark.
J Am Coll Emerg Physicians Open. 2020 Apr 1;1(3):163-172. doi: 10.1002/emp2.12036. eCollection 2020 Jun.
To validate the discrimination and classification accuracy of a novel acute dyspnea scale for identifying outcomes of out-of-hospital patients with acute dyspnea.
Prospective observational population-based study in the North Denmark Region. We included patients from July 1, 2017 to September 24, 2019 assessed as having acute dyspnea by the emergency dispatcher or by emergency medical services (EMS) personnel. Patients rated dyspnea using the 11-point acute dyspnea scale. The primary outcomes were hospitalization >2 days, ICU admission within 48 hours of ambulance run, and 30-day mortality. We used 5-fold cross-validation and area under receiver operating curves (AUC) to assess predictive properties of the acute dyspnea scale score alone and combined with vital data, age, and sex.
We included 3144 EMS patients with reported dyspnea. Median acute dyspnea scale score was 7 (interquartile range 5 to 8). The outcomes were: 1966 (63%) hospitalized, 164 (5%) ICU stay, and 224 (9%) died within 30 days of calling the ambulance. The acute dyspnea scale score alone showed poor discrimination for hospitalization (AUC 0.56, 95% confidence intervals: 0.54-0.58), intensive care unit admission (0.58, 0.53-0.62), and mortality (0.46, 0.41-0.50). Vital signs (respiratory rate, blood oxygen saturation, blood pressure, and heart rate) showed similarly poor discrimination for all outcomes. The combination of [vital signs + acute dyspnea scale score] showed better discrimination for hospitalization, ICU admission, and mortality (AUC 0.71-0.72). Patients not able to report an acute dyspnea scale score worse outcomes on all parameters.
The dyspnea scale showed poor accuracy and discrimination when predicting hospitalization, stay at intensive care unit, and mortality on its own. However, the dyspnea scale may be beneficial as performance measure and indicator of out-of-hospital care.
验证一种新型急性呼吸困难量表对识别院外急性呼吸困难患者预后的鉴别能力和分类准确性。
在丹麦北部地区进行基于人群的前瞻性观察研究。纳入2017年7月1日至2019年9月24日期间经急救调度员或紧急医疗服务（EMS）人员评估为急性呼吸困难的患者。患者使用11点急性呼吸困难量表对呼吸困难进行评分。主要结局为住院时间>2天、救护车出诊后48小时内入住重症监护病房（ICU）以及30天死亡率。我们采用5折交叉验证和受试者操作特征曲线下面积（AUC）来评估单独的急性呼吸困难量表评分以及结合生命体征、年龄和性别后的预测性能。
我们纳入了3144例报告有呼吸困难的EMS患者。急性呼吸困难量表评分中位数为7（四分位间距5至8）。结局如下：1966例（63%）住院，164例（5%）入住ICU，224例（9%）在呼叫救护车后30天内死亡。单独的急性呼吸困难量表评分对住院（AUC 0.56，95%置信区间：0.54 - 0.58）、重症监护病房入住（0.58，0.53 - 0.62）和死亡率（0.46，0.41 - 0.50）的鉴别能力较差。生命体征（呼吸频率、血氧饱和度、血压和心率）对所有结局的鉴别能力同样较差。[生命体征 + 急性呼吸困难量表评分]的组合对住院、ICU入住和死亡率的鉴别能力较好（AUC 0.71 - 0.72）。无法报告急性呼吸困难量表评分的患者在所有参数上的结局更差。
该呼吸困难量表在单独预测住院、入住重症监护病房和死亡率时准确性和鉴别能力较差。然而，该呼吸困难量表作为院外护理的绩效指标可能有益。
