Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark.
Research Centre for Emergency Medicine, Aarhus University, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2021 Oct;65(9):1337-1344. doi: 10.1111/aas.13929. Epub 2021 Jun 28.
Studies have suggested that adding subjective parameters to early warning score (EWS) systems might prompt more proactive treatment and positively affect clinical outcomes. Hence, the study aimed to investigate effect of a situation awareness model consisting of objective and subjective parameters on clinical deterioration in adult emergency department (ED) patients.
This controlled pre-and-post interventional study was carried out in July-December 2016 and November 2017-April 2018. In ED patients ≥ 18 years, we examined if a situation awareness model compared with a conventional EWS system could reduce clinical deterioration. The new model consisted of a regional EWS, combined with skin observation, clinical concern and patients' and relatives' concerns, pain, dyspnea, and team risk assessment. Clinical deterioration was defined as change in vital signs requiring increased observation or physician assessment, that is, increase in early warning score from either 0 or 1 to score ≥2 or an increase from score ≥2 and above. Secondary outcomes were mortality, intensive care unit (ICU) admissions, and readmissions.
We included 34 556 patients. Patients with two or more registered EWS were included in the primary analysis (N = 21 839). Using difference-in-difference regression, we found a reduced odds of clinical deterioration of 21% (OR 0.79 95% CI [0.69; 0.90]) in the intervention groups compared with controls. No impact on mortality, ICU, or readmissions was found.
The situation awareness model reduces odds of clinical deterioration, defined as a clinically relevant increase in EWS, in an unselected adult population of ED patients. However, there was no effect on secondary outcomes.
研究表明，在早期预警评分（EWS）系统中加入主观参数可能会促使更积极的治疗，并对临床结果产生积极影响。因此，本研究旨在探讨由客观和主观参数组成的情境意识模型对成人急诊科（ED）患者临床恶化的影响。
这是一项 2016 年 7 月至 12 月和 2017 年 11 月至 2018 年 4 月进行的对照性预-后干预研究。在 ED 患者≥18 岁时，我们检查了情境意识模型是否与传统 EWS 系统相比可以减少临床恶化。新模型由区域 EWS 组成，结合皮肤观察、临床关注以及患者和家属的关注、疼痛、呼吸困难和团队风险评估。临床恶化定义为需要增加观察或医生评估的生命体征变化，即从 0 或 1 分增加到≥2 分的早期预警评分变化，或从≥2 分增加的变化。次要结局为死亡率、重症监护病房（ICU）入院和再入院。
我们纳入了 34556 名患者。在主要分析中，将两个或多个登记的 EWS 的患者纳入（N=21839）。使用差异中的差异回归，我们发现干预组的临床恶化几率降低了 21%（OR 0.79 95% CI [0.69; 0.90]）。没有发现对死亡率、ICU 或再入院的影响。
情境意识模型降低了未经选择的成年 ED 患者群体中临床恶化的几率，定义为 EWS 临床相关的增加。然而，对次要结局没有影响。
