Haruna Junpei, Tatsumi Hiroomi, Kazuma Satoshi, Kuroda Hiromitsu, Goto Yuya, Aisaka Wakiko, Terada Hirofumi, Sonoda Tomoko, Masuda Yoshiki
Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
J Crit Care Med (Targu Mures). 2021 Nov 6;7(4):283-289. doi: 10.2478/jccm-2021-0040. eCollection 2021 Oct.
The medical emergency team enables the limitation of patients' progression to critical illness in the general ward. The early warning scoring system (EWS) is one of the criteria for medical emergency team activation; however, it is not a valid criterion to predict the prognosis of patients with MET activation.
In this study, the National Early Warning Score (NEWS) and Rapid Emergency Medicine Score (REMS) was compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting the prognosis of patients who had been treated a medical emergency team.
In this single-centre retrospective cohort study, patients treated by a medical emergency team between April 2013 and March 2019 and the 28-day prognosis of MET-activated patients were assessed using APACHE II, NEWS, and REMS.
Of the 196 patients enrolled, 152 (77.5%) were men, and 44 (22.5%) were women. Their median age was 68 years (interquartile range: 57-76 years). The most common cause of medical emergency team activation was respiratory failure (43.4%). Univariate analysis showed that APACHE II score, NEWS, and REMS were associated with 28-day prognostic mortality. There was no significant difference in the area under the receiver operating characteristic curve of APACHE II (0.76), NEWS (0.67), and REMS (0.70); however, the sensitivity of NEWS (0.70) was superior to that of REMS (0.47).
NEWS is a more sensitive screening tool like APACHE II than REMS for predicting the prognosis of patients with medical emergency team activation. However, because the accuracy of NEWS was not sufficient compared with that of APACHE II score, it is necessary to develop a screening tool with higher sensitivity and accuracy that can be easily calculated at the bedside in the general ward.
医疗急救团队有助于限制普通病房患者发展为危重症。早期预警评分系统（EWS）是启动医疗急救团队的标准之一；然而，它并非预测医疗急救团队启动患者预后的有效标准。
本研究比较了国家早期预警评分（NEWS）和快速急诊医学评分（REMS）与急性生理与慢性健康状况评估II（APACHE II）评分在预测接受医疗急救团队治疗患者预后方面的效果。
在这项单中心回顾性队列研究中，使用APACHE II、NEWS和REMS对2013年4月至2019年3月期间接受医疗急救团队治疗的患者以及医疗急救团队启动患者的28天预后进行评估。
纳入的196例患者中，152例（77.5%）为男性，44例（22.5%）为女性。他们的中位年龄为68岁（四分位间距：57 - 76岁）。启动医疗急救团队最常见的原因是呼吸衰竭（43.4%）。单因素分析显示，APACHE II评分、NEWS和REMS与28天预后死亡率相关。APACHE II（0.76）、NEWS（0.67）和REMS（0.70）的受试者工作特征曲线下面积无显著差异；然而，NEWS的敏感度（0.70）优于REMS（0.47）。
对于预测医疗急救团队启动患者的预后，NEWS与APACHE II一样是比REMS更敏感的筛查工具。然而，由于NEWS的准确性与APACHE II评分相比不足，有必要开发一种在普通病房床边易于计算且具有更高敏感度和准确性的筛查工具。
