Prehosp Emerg Care. 2022 May-Jun;26(3):391-399. doi: 10.1080/10903127.2021.1908464. Epub 2021 Apr 13.
For patients at risk for out-of-hospital cardiac arrest (OHCA) after Emergency Medical Services (EMS) arrival, outcomes may be mitigated by identifying impending arrests and intervening before they occur. Tools such as the Modified Early Warning Score (MEWS) have been developed to determine the risk of arrest, but involve relatively complicated algorithms that can be impractical to compute in the prehospital environment. A simple count of abnormal vital signs, the "EMS Modified Early Warning Score" (EMEWS), may represent a more practical alternative. We sought to compare to the ability of MEWS and EMEWS to identify patients at risk for EMS-witnessed OHCA. We conducted a retrospect analysis of the 2018 ESO Data Collaborative database of EMS encounters. Patients without cardiac arrest before EMS arrival were categorized into those who did or did not have an EMS-witnessed arrest. MEWS was evaluated without its temperature component (MEWS-T). The performance of MEWS-T and EMEWS in predicting EMS witnessed arrest was evaluated by comparing receiver-operating characteristic curves. Of 369,064 included encounters, 4,651 were EMS witnessed arrests. MEWS-T demonstrated an area under the curve (AUC) of 0.79 (95% CI: 0.79 - 0.80), with 86.8% sensitivity and 51.0% specificity for MEWS-T ≥ 3. EMEWS demonstrated an AUC of 0.74 (95% CI: 0.73 - 0.75), with 81.3% sensitivity and 53.9% specificity for EMEWS ≥ 2. EMEWS showed a similar ability to predict EMS-witnessed cardiac arrest compared to MEWS-T, despite being significantly simpler to compute. Further study is needed to evaluate whether the implementation of EMEWS can aid EMS clinicians in anticipating and preventing OHCA.
对于在紧急医疗服务（EMS）到达后有发生院外心脏骤停（OHCA）风险的患者，通过识别即将发生的心脏骤停并在其发生之前进行干预，可能会改善结局。已经开发了一些工具，如改良早期预警评分（MEWS），以确定心脏骤停的风险，但涉及到相对复杂的算法，在院前环境中计算可能不切实际。一个简单的异常生命体征计数，即“EMS 改良早期预警评分”（EMEWS），可能代表了更实用的替代方案。我们试图比较 MEWS 和 EMEWS 识别有 EMS 目击 OHCA 风险的患者的能力。我们对 2018 年 ESO Data 协作数据库中的 EMS 接触进行了回顾性分析。在 EMS 到达前没有心脏骤停的患者被分为有或没有 EMS 目击的心脏骤停。不包括 MEWS 的体温成分（MEWS-T）来评估 MEWS-T。通过比较接受者操作特征曲线来评估 MEWS-T 和 EMEWS 在预测 EMS 目击的心脏骤停中的表现。在纳入的 369,064 次接触中，有 4,651 次为 EMS 目击的心脏骤停。MEWS-T 的曲线下面积（AUC）为 0.79（95%CI：0.79-0.80），MEWS-T≥3 时的敏感性为 86.8%，特异性为 51.0%。EMEWS 的 AUC 为 0.74（95%CI：0.73-0.75），EMEWS≥2 时的敏感性为 81.3%，特异性为 53.9%。尽管 EMEWS 的计算更为简单，但它预测 EMS 目击的心脏骤停的能力与 MEWS-T 相似。需要进一步的研究来评估实施 EMEWS 是否可以帮助 EMS 临床医生预测和预防 OHCA。
