Latten Gideon H P, Polak Judith, Merry Audrey H H, Muris Jean W M, Ter Maaten Jan C, Olgers Tycho J, Cals Jochen W L, Stassen Patricia M
Emergency Department, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
Zuyderland Academy, Zuyderland Medical Centre, Heerlen, The Netherlands.
Int J Emerg Med. 2021 Nov 27;14(1):69. doi: 10.1186/s12245-021-00388-z.
For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection.
Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations.
We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7-17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3-65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations.
After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6-15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.
对于急诊科疑似感染患者，通常在患者到达后不久计算基于生命体征的临床规则。临床规则评分（正常或异常）提供有关诊断和/或预后的信息。由于生命体征随时间变化，临床规则评分也可能改变。在这项前瞻性多中心研究中，我们调查了在疑似感染患者的急诊科留观期间，四种常用临床规则的评分变化频率。
2016年3月至2019年12月期间，荷兰三家急诊科前瞻性纳入了疑似感染的成年（≥18岁）患者。每30分钟测量一次生命体征，并计算快速序贯器官衰竭评估（qSOFA）评分、全身炎症反应综合征（SIRS）标准、改良早期预警评分和国家早期预警评分（NEWS）。使用既定的临界值，我们分析了临床规则评分改变的频率（即从正常变为异常或反之）。此外，我们调查了哪些生命体征导致了最多的改变。
我们纳入了1433例患者，其中637例（44.5%）患者的临床规则评分发生了一次或多次变化。在初始临床规则评分为阴性的患者中，6.7%-17.5%（取决于临床规则）在急诊科留观后期出现了阳性评分。在初始临床规则评分为阳性的患者中，超过一半（54.3%-65.0%）的患者评分后来变为阴性。呼吸频率导致的改变最多（51.2%）。
在急诊科就诊后，几乎一半的疑似感染患者的qSOFA、SIRS、MEWS和/或NEWS评分会发生改变。导致这些改变的最主要生命体征是呼吸频率。每6-15名患者中就有1名在初始评分正常后出现异常临床规则评分。临床医生应意识到临床规则评分改变的频率，因为临床规则广泛用于诊断和/或预后评估，而评估它们的最佳时机尚不清楚。
