Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Respir Res. 2021 Feb 18;22(1):60. doi: 10.1186/s12931-021-01660-9.
Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes.
Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS < 5 days) and late deterioration (LOS ≥ 5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors.
Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44-1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45-1.91).
Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.
快速反应系统（RRS）在全球范围内被越来越多地采用，以提高医院的患者安全性。然而，由于意外临床恶化而激活 RRS 后的生存结果的预测因素尚未得到很好的定义。我们研究了 RRS 激活前的住院时间（LOS）是否可以预测临床结果。
我们使用全国多中心 RRS 数据库，确定了 2016 年 1 月 1 日至 2017 年 12 月 31 日期间在韩国 9 家三级转诊医院住院期间因意外临床恶化而激活 RRS 的患者。每个中心回顾患者病历，收集患者特征、RRS 激活和临床结果的所有信息。根据 RRS 激活前的住院 LOS 将患者分为两组：早期恶化（LOS<5 天）和晚期恶化（LOS≥5 天）。主要结局是 28 天死亡率，并使用多变量逻辑回归比较两组。此外，还使用倾向评分匹配分析来最小化混杂因素的影响。
在 11612 名患者中，5779 名和 5883 名患者分别属于早期和晚期恶化组。晚期恶化组的患者更有可能患有恶性疾病，并且在 RRS 激活时病情更严重。调整混杂因素后，晚期恶化组的 28 天死亡率更高（调整后优势比 1.60，95%置信区间 1.44-1.77）。晚期恶化组的其他临床结局（住院死亡率和 RRS 激活后的住院 LOS）也较差，倾向评分匹配分析也得出了类似的结果（28 天死亡率的调整后优势比 1.66，95%置信区间 1.45-1.91）。
在 RRS 激活前住院时间较长的患者临床结局较差。在 RRS 团队对患者进行评估期间，应将 RRS 激活前的住院 LOS 视为未来结局的预测因素。
