National Taiwan University Hospital Department of Emergency Medicine, Taipei, Taiwan.
National Taiwan University College of Medicine, Department of Emergency Medicine, Taipei, Taiwan.
West J Emerg Med. 2022 Feb 23;23(2):258-267. doi: 10.5811/westjem.2021.8.53063.
Early recognition and prevention of in-hospital cardiac arrest (IHCA) have played an increasingly important role in the chain of survival. However, clinical tools for predicting IHCA are scarce, particularly in the emergency department (ED). We sought to estimate the incidence of ED-based IHCA and to develop and validate a novel triage tool, the Emergency Department In-hospital Cardiac Arrest Score (EDICAS), for predicting ED-based IHCA.
In this retrospective cohort study we used electronic clinical warehouse data from a tertiary medical center with approximately 100,000 ED visits per year. We extracted data from 733,398 ED visits over a seven-year period. We selected one ED visit per person and excluded out-of-hospital cardiac arrest or children. Patient demographics and computerized triage information were included as potential predictors.
A total of 325,502 adult ED patients were included. Of these patients, 623 (0.2%) developed ED-based IHCA. The EDICAS, which includes age and arrival mode and categorizes vital signs with simple cut-offs, showed excellent discrimination (area under the receiver operating characteristic [AUROC] curve, 0.87) and maintained its discriminatory ability (AUROC, 0.86) in cross-validation. Previously developed early warning scores showed lower AUROC (0.77 for the Modified Early Warning Score and 0.83 for the National Early Warning Score) when applied to our ED population.
In-hospital cardiac arrest in the ED is relatively uncommon. We developed and internally validated a novel tool for predicting imminent IHCA in the ED. Future studies are warranted to determine whether this tool could gain lead time to identify high-risk patients and potentially reduce ED-based IHCA.
院内心脏骤停（IHCA）的早期识别和预防在生存链中发挥着越来越重要的作用。然而，预测 IHCA 的临床工具仍然匮乏，尤其是在急诊科（ED）。我们旨在评估 ED 基础上 IHCA 的发生率，并开发和验证一种新的分诊工具，即急诊室院内心脏骤停评分（EDICAS），用于预测 ED 基础上的 IHCA。
本回顾性队列研究使用了一家拥有每年约 10 万例 ED 就诊量的三级医疗中心的电子临床仓库数据。我们从 733398 例 ED 就诊中提取了数据，时间跨度为 7 年。我们为每位患者选择了一次 ED 就诊，并排除了院外心脏骤停或儿童。患者的人口统计学和计算机分诊信息被纳入潜在的预测因素。
共有 325502 例成年 ED 患者被纳入研究。其中，623 例（0.2%）发生 ED 基础上的 IHCA。EDICAS 包括年龄和到达方式，并使用简单的截断值对生命体征进行分类，其具有出色的判别能力（接受者操作特征曲线下面积 [AUROC]，0.87），并在交叉验证中保持其判别能力（AUROC，0.86）。当应用于我们的 ED 人群时，先前开发的早期预警评分的 AUROC 较低（改良早期预警评分 0.77，国家早期预警评分 0.83）。
ED 中的院内心脏骤停相对少见。我们开发并内部验证了一种用于预测 ED 中即将发生的 IHCA 的新工具。未来的研究需要确定该工具是否可以获得识别高危患者的先机，并可能降低 ED 基础上的 IHCA 发生率。
