College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea.
Department of Gastroenterology, Kyung Hee University Gangdong Korean Medicine Hospital, Seoul, Republic of Korea.
Asian Nurs Res (Korean Soc Nurs Sci). 2023 May;17(2):110-117. doi: 10.1016/j.anr.2023.04.003. Epub 2023 May 2.
This study aims to examine the performance of early warning scoring systems regarding adverse events of unanticipated clinical deterioration in complementary and alternative medicine hospitals.
A medical record review of 500 patients from 5-year patient data in two traditional Korean medicine hospitals was conducted. Unanticipated clinical deterioration events included unexpected in-hospital mortality, cardiac arrest, and unplanned transfers to acute-care conventional medicine hospitals. Scores of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and National Early Warning Score 2 (NEWS2) were calculated. Their performance was evaluated by calculating areas under the receiver-operating characteristic curve for the event occurrence. Multiple logistic regression analyses were performed to determine the factors associated with event occurrence.
The incidence of unanticipated clinical deterioration events was 1.1% (225/21101). The area under the curve of MEWS, NEWS, and NEWS2 was .68, .72, and .72 at 24 hours before the events, respectively. NEWS and NEWS2, with almost the same performance, were superior to MEWS (p = .009). After adjusting for other variables, patients at low-medium risk (OR = 3.28; 95% CI = 1.02-10.55) and those at medium and high risk (OR = 25.03; 95% CI = 2.78-225.46) on NEWS2 scores were more likely to experience unanticipated clinical deterioration than those at low risk. Other factors associated with the event occurrence included frailty risk scores, clinical worry scores, primary medical diagnosis, prescribed medicine administration, acupuncture treatment, and clinical department.
The three early warning scores demonstrated moderate-to-fair performance for clinical deterioration events. NEWS2 can be used for early identification of patients at high risk of deterioration in complementary and alternative medicine hospitals. Additionally, patient, care, and system factors need to be considered to improve patient safety.
本研究旨在探讨预警评分系统在补充和替代医学医院中对意外临床恶化不良事件的表现。
对两家传统韩国医学医院 5 年患者数据中的 500 名患者进行病历回顾。意外临床恶化事件包括院内意外死亡、心脏骤停和非计划转入急性常规医学医院。计算改良早期预警评分（MEWS）、国家早期预警评分（NEWS）和国家早期预警评分 2（NEWS2）的评分。通过计算事件发生时的受试者工作特征曲线下面积来评估它们的性能。进行多变量逻辑回归分析，以确定与事件发生相关的因素。
意外临床恶化事件的发生率为 1.1%（225/21101）。MEWS、NEWS 和 NEWS2 在事件发生前 24 小时的曲线下面积分别为.68、.72 和.72。NEWS 和 NEWS2 的性能几乎相同，优于 MEWS（p=.009）。调整其他变量后，NEWS2 评分处于低中危（OR=3.28；95%CI=1.02-10.55）和中高危（OR=25.03；95%CI=2.78-225.46）的患者比低危患者更有可能经历意外的临床恶化。与事件发生相关的其他因素包括虚弱风险评分、临床担忧评分、主要医疗诊断、规定药物管理、针刺治疗和临床科室。
三种预警评分对临床恶化事件的表现为中等到良好。NEWS2 可用于识别补充和替代医学医院中病情恶化风险较高的患者。此外，需要考虑患者、护理和系统因素，以提高患者安全性。
