Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Intensive Care Med. 2021 May;36(5):542-549. doi: 10.1177/0885066620978140. Epub 2021 Feb 3.
We sought to evaluate if incorporating an early warning system (EWS), the Visensia Safety Index (VSI) and the National Early Warning Systems 2 (NEWS2), may lead to earlier identification of rapid response team (RRT) patients.
This was a retrospective study (2015-2018) of patients experiencing RRT activation within a tertiary care network. We evaluated the proportion of patients with an EWS alert prior to RRT activation and their associated outcomes (primary: hospital mortality).
There were 6,346 RRT activations over the study period. Of these, 2042 (50.8%) patients would have had a VSI alert prior to RRT activation, with a median advanced time of 3.6 (IQR 0.5-12.8) hours, compared to 2351 (58.4%) patients and 9.8 (IQR 2.0-18.7) hours for NEWS2. Patients with a potential alert prior to RRT activation had an increased odds of mortality for both VSI (OR 1.2, 95%CI 1.1-1.3) and NEWS2 (OR 2.7, 95% CI 2.4-3.1). Prognostic accuracy for hospital mortality was similar between groups.
Utilization of an EWS by an RRT has potential to provide earlier recognition of deterioration and mortality risk among hospitalized inpatients.
我们旨在评估早期预警系统（EWS）、Visensia 安全指数（VSI）和国家早期预警系统 2 （NEWS2）的应用是否能更早识别快速反应团队（RRT）患者。
这是一项对三级护理网络中发生 RRT 激活的患者进行的回顾性研究（2015-2018 年）。我们评估了在 RRT 激活前有 EWS 警报的患者比例及其相关结局（主要结局：医院死亡率）。
研究期间共发生 6346 次 RRT 激活。其中，2042 例（50.8%）患者在 RRT 激活前会有 VSI 警报，其高级预警时间中位数为 3.6（IQR 0.5-12.8）小时，而 NEWS2 则为 2351 例（58.4%）患者和 9.8（IQR 2.0-18.7）小时。在 RRT 激活前有潜在警报的患者，其死亡的可能性对于 VSI（OR 1.2，95%CI 1.1-1.3）和 NEWS2（OR 2.7，95%CI 2.4-3.1）均有增加。两组患者的医院死亡率预测准确性相似。
RRT 使用 EWS 有潜力更早识别住院患者的恶化和死亡风险。
