Tan Armand Delo Antone, Permejo Chito Caimoy, Torres Ma Consolacion Dolor
Department of Adult Cardiology, Philippine Heart Center, Quezon City, Philippines.
Critical Care Medicine Division, Department of Ambulatory, Emergency and Critical Care, Philippine Heart Center, Quezon City, Philippines.
Indian J Crit Care Med. 2022 Jul;26(7):780-785. doi: 10.5005/jp-journals-10071-24242.
Delayed transfer to the intensive care unit (ICU) contributes to increased mortality. Clinical tools, developed to shorten this delay, are especially useful in hospitals where the ideal healthcare provider-to-patient ratio is not met. This study aimed to validate and compare the accuracy of the well-accepted modified early warning score (MEWS) and the newer cardiac arrest risk triage (CART) score in the Philippine setting.
This case-control study involved 82 adult patients admitted to the Philippine Heart Center. Patients who had cardiopulmonary (CP) arrest at the wards and those transferred to the ICU were included. Vital signs and alert-verbal-pain-unresponsive (AVPU) scales were recorded from recruitment until 48 hours prior to CP arrest or ICU transfer. The MEWS and CART scores were computed at specific time points and compared using measures of validity.
The highest accuracy was obtained by the CART score with a cut-off of ≥12 at 8 hours prior to CP arrest or ICU transfer, with a specificity of 80.43% and sensitivity of 66.67%. At this time point, the MEWS with a cut-off of ≥3 had a specificity of 78.26% but a lower sensitivity of 58.33%. The area under the curve (AUC) analysis revealed that these differences were not statistically significant.
We recommend an MEWS threshold of 3 and a CART score threshold of 12 to help identify patients at risk for clinical deterioration. The CART score had comparable accuracy to the MEWS, but the latter's computation may be easier.
Tan ADA, Permejo CC, Torres MCD. Modified Early Warning Score vs Cardiac Arrest Risk Triage Score for Prediction of Cardiopulmonary Arrest: A Case-Control Study. Indian J Crit Care Med 2022;26(7):780-785.
延迟转入重症监护病房（ICU）会导致死亡率上升。为缩短这一延迟而开发的临床工具，在未达到理想医护人员与患者比例的医院中尤为有用。本研究旨在验证并比较在菲律宾环境下，广为人知的改良早期预警评分（MEWS）和较新的心脏骤停风险分诊（CART）评分的准确性。
这项病例对照研究纳入了82名入住菲律宾心脏中心的成年患者。包括在病房发生心肺（CP）骤停的患者以及转入ICU的患者。从招募开始直至CP骤停或转入ICU前48小时，记录生命体征和清醒-语言-疼痛-无反应（AVPU）量表。在特定时间点计算MEWS和CART评分，并使用效度指标进行比较。
在CP骤停或转入ICU前8小时，CART评分截断值≥12时准确性最高，特异性为80.43%，敏感性为66.67%。此时，截断值≥3的MEWS特异性为78.26%，但敏感性较低，为58.33%。曲线下面积（AUC）分析显示，这些差异无统计学意义。
我们建议MEWS阈值为3，CART评分阈值为12，以帮助识别有临床病情恶化风险的患者。CART评分与MEWS的准确性相当，但后者的计算可能更简便。
Tan ADA, Permejo CC, Torres MCD. 改良早期预警评分与心脏骤停风险分诊评分对心肺骤停的预测：一项病例对照研究。《印度重症监护医学杂志》2022；26(7):780 - 785。
