Medical Emergency Team, Asan Medical Center, Seoul, Republic of Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2021 Feb 19;16(2):e0247066. doi: 10.1371/journal.pone.0247066. eCollection 2021.
The rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality.
We retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2-7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes.
Overall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46-1.93).
Nearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.
快速反应系统已在全球许多医院实施，据报道，医疗急救小组（MET）的响应时间与 MET 患者的死亡率相关。我们评估了 MET 激活前的住院时间与患者死亡率之间的关系。我们比较了 MET 激活早期、中期和晚期病情恶化的病例与患者特征、激活特征和患者结局。我们还旨在确定在调整混杂因素后，MET 激活前的住院时间与患者死亡率之间的关系。
我们回顾性评估了 2009 年 3 月至 2015 年 2 月在首尔峨山医学中心普通病房触发 MET 激活的患者。患者分为早期恶化（入院后不到 2 天）、中期恶化（入院后 2-7 天）和晚期恶化（入院后超过 7 天），并将其与患者特征、激活特征和患者结局进行比较。
共有 7114 例患者纳入研究。其中，1793 例（25.2%）表现为早期恶化，2113 例（29.7%）表现为中期恶化，3208 例（45.1%）表现为晚期恶化。这些组之间的 MET 激活病因相似。临床结局在这些组之间有显著差异（转入重症监护病房：34.1%、35.6%和 40.4%；p<0.001和死亡率：26.3%、31.5%和 41.2%；p<0.001，分别为早期、中期和晚期恶化）。与早期恶化相比，在调整混杂因素后，晚期恶化的死亡率比值比为 1.68（1.46-1.93）。
近 50%的急性临床恶化患者激活 MET 时已住院超过 7 天。此外，他们的死亡率和 ICU 转移率高于 MET 激活前住院不到 7 天的患者，且死亡率是独立的危险因素。
