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建立一个简化的评分系统,以预测危重症患者院内转运期间的风险:一项前瞻性队列研究。

Establishment of a simplified score for predicting risk during intrahospital transport of critical patients: A prospective cohort study.

机构信息

Nursing Department, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Emergency Department, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

出版信息

J Clin Nurs. 2023 Apr;32(7-8):1125-1134. doi: 10.1111/jocn.16337. Epub 2022 Jun 3.

Abstract

AIMS AND OBJECTIVES

To establish a simple score that enables nurses to quickly, conveniently and accurately identify patients whose condition may change during intrahospital transport.

BACKGROUND

Critically ill patients may experience various complications during intrahospital transport; therefore, it is important to predict their risk before they leave the emergency department. The existing scoring systems were not developed for this population.

DESIGN

A prospective cohort study.

METHODS

This study used convenience sampling and continuous enrolment from 1 January, 2019, to 30 June, 2021, and 584 critically ill patients were included. The collected data included vital signs and any condition change during transfer. The STROBE checklist was used.

RESULTS

The median age of the modelling group was 74 (62, 83) years; 93 (19.7%) patients were included in the changed group, and 379 (80.3%) were included in the stable group. The five independent model variables (respiration, pulse, oxygen saturation, systolic pressure and consciousness) were statistically significant (p < .05). The above model was simplified based on beta coefficient values, and each variable was assigned 1 point, for a total score of 0-5 points. The AUC of the simplified score in the modelling group was 0.724 (95% CI: 0.682-0.764); the AUC of the simplified score in the validation group (112 patients) was 0.657 (95% CI: 0.566-0.741).

CONCLUSIONS

This study preliminarily established a simplified scoring system for the prediction of risk during intrahospital transport from the emergency department to the intensive care unit. It provides emergency nursing staff with a simple assessment tool to quickly, conveniently and accurately identify a patient's transport risk.

RELEVANCE TO CLINICAL PRACTICE

This study suggested the importance of strengthening the evaluation of the status of critical patients before intrahospital transport, and a simple score was formed to guide emergency department nurses in evaluating patients.

摘要

目的和目标

建立一个简单的评分系统,使护士能够快速、方便、准确地识别在院内转运过程中病情可能发生变化的患者。

背景

危重症患者在院内转运过程中可能会出现各种并发症;因此,在他们离开急诊部之前预测他们的风险很重要。现有的评分系统并不是为此人群开发的。

设计

前瞻性队列研究。

方法

本研究使用便利抽样法,于 2019 年 1 月 1 日至 2021 年 6 月 30 日连续纳入 584 例危重症患者。收集的数据包括转运过程中的生命体征和任何病情变化。使用 STROBE 清单。

结果

建模组的中位年龄为 74(62,83)岁;93(19.7%)例患者纳入变化组,379(80.3%)例患者纳入稳定组。5 个独立的模型变量(呼吸、脉搏、氧饱和度、收缩压和意识)具有统计学意义(p<0.05)。基于β系数值简化了上述模型,每个变量赋值 1 分,总分为 0-5 分。建模组简化评分的 AUC 为 0.724(95%CI:0.682-0.764);验证组(112 例患者)简化评分的 AUC 为 0.657(95%CI:0.566-0.741)。

结论

本研究初步建立了一个从急诊科到重症监护病房的院内转运风险预测简化评分系统。它为急诊护理人员提供了一种简单的评估工具,可快速、方便、准确地识别患者的转运风险。

临床相关性

本研究提示了在院内转运前加强对危重症患者病情评估的重要性,并形成了一个简单的评分来指导急诊科护士对患者进行评估。

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