Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Intensive Care, Northern Health, Epping, Victoria, Australia; Division of Digital Health, Northern Health, Epping, Victoria, Australia.
Division of Digital Health, Northern Health, Epping, Victoria, Australia.
Aust Crit Care. 2023 Nov;36(6):1078-1083. doi: 10.1016/j.aucc.2023.03.002. Epub 2023 Apr 17.
Pre-medical emergency team (MET) calls are an increasingly common tier of Rapid Response Systems, but the epidemiology of patients who trigger a Pre-MET is not well understoof.
This study aims to examine the epidemiology and outcomes of patients who trigger a pre-MET activation and identify risk factors for further deterioration.
This is a retrospective cohort study of pre-MET activations in a university-affiliated metropolitan hospital in Australia, between 13 April 2021 and 4 October 2021. A multivariable regression model was used to identify variables associated with further deterioration, defined as a MET call or Code Blue within 24 h of pre-MET activation.
From a total of 39 664 admissions, there were 7823 pre-MET activations (197.2 per 1000 admissions). Compared to inpatients that did not trigger a pre-MET, the patients were older (68.8 vs 53.8 years, p < 0.001), were more likely to be male (51.0 vs 47.6%, p < 0.001), had an emergency admission (70.1% vs 53.3%, p < 0.001), and were under a medical specialty (63.7 vs 54.9%, p < 0.001). They had a longer hospital length of stay (5.6 vs 0.4 d, p < 0.001) and higher in-hospital mortality (3.4% vs 1.0%, p < 0.001). A pre-MET was more likely to progress to a MET call or Code Blue if it was activated for fever, cardiovascular, neurological, renal, or respiratory criteria (p < 0.001), if the patient was under a paediatric team (p = 0.018), or if there had been a MET call or Code Blue prior to the pre-MET activation (p < 0.001).
Pre-MET activations affect almost 20% of hospital admissions and are associated with a higher risk of mortality. Certain characteristics may predict further deterioration to a MET call or Code Blue, suggesting the potential for early intervention via clinical decision support systems.
医预紧急小组（MET）电话是快速反应系统中越来越常见的一层，但触发医预的患者的流行病学情况并不清楚。
本研究旨在检查触发医预激活的患者的流行病学和结果，并确定进一步恶化的危险因素。
这是一项在澳大利亚一所大学附属医院进行的医预激活的回顾性队列研究，时间为 2021 年 4 月 13 日至 2021 年 10 月 4 日。使用多变量回归模型确定与进一步恶化相关的变量，定义为医预激活后 24 小时内发生 MET 电话或 Code Blue。
在总共 39664 例住院患者中，有 7823 例医预激活（每 1000 例住院患者中有 197.2 例）。与未触发医预的住院患者相比，这些患者年龄更大（68.8 岁 vs 53.8 岁，p < 0.001），更可能是男性（51.0% vs 47.6%，p < 0.001），为紧急入院（70.1% vs 53.3%，p < 0.001），并在医疗专科下（63.7% vs 54.9%，p < 0.001）。他们的住院时间更长（5.6 天 vs 0.4 天，p < 0.001），住院死亡率更高（3.4% vs 1.0%，p < 0.001）。如果医预激活的标准是发热、心血管、神经、肾脏或呼吸标准（p < 0.001），如果患者在儿科团队下（p = 0.018），或者在医预激活之前已经发生了 MET 电话或 Code Blue（p < 0.001），则更有可能进展为 MET 电话或 Code Blue。
医预激活几乎影响了 20%的住院患者，并且与更高的死亡率相关。某些特征可能预示着进一步恶化至 MET 电话或 Code Blue，这表明通过临床决策支持系统进行早期干预的潜力。
