Kovoor Joshua G, Bacchi Stephen, Stretton Brandon, Gupta Aashray K, Lam Lydia, Jiang Melinda, Lee Shane, To Minh-Son, Ovenden Christopher D, Hewitt Joseph N, Goh Rudy, Gluck Samuel, Reid Jessica L, Hugh Thomas J, Dobbins Christopher, Padbury Robert T, Hewett Peter J, Trochsler Markus I, Flabouris Arthas, Maddern Guy J
University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
ANZ J Surg. 2023 Oct;93(10):2426-2432. doi: 10.1111/ans.18648. Epub 2023 Aug 13.
The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria.
A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in-hospital mortality.
15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in-hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71-49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82-19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79-14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs.
This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in-hospital mortality in a large cohort of patients admitted to general surgical services in South Australia.
生命体征提示启动医疗急救响应（MER）的适用性此前尚未在大型普通外科队列中进行专门研究。本研究旨在描述根据澳大利亚指南选择的四项生命体征（血氧饱和度、呼吸频率、收缩压和心率）的分布及预测性能，并与MER启动标准的生命体征进行比较。
进行了一项回顾性队列研究，纳入了南澳大利亚两家医院普通外科服务收治的患者，为期2年。计算符合MER启动标准或生命体征处于普通外科住院患者最极端1%（<第0.5百分位数或>第99.5百分位数）的患者的似然比，以预测院内死亡率。
共纳入15969例住院患者，总计2254617次生命体征观察。心率的第0.5百分位数和第99.5百分位数分别为48和133，收缩压为85和184，呼吸频率为10和31，血氧饱和度为89%和100%。对于院内死亡率，具有最高阳性似然比的MER启动标准为心率≤39（37.65，95%可信区间27.71 - 49.51）、呼吸频率≥31（15.79，95%可信区间12.82 - 19.07）以及呼吸频率≤7（10.53，95%可信区间6.79 - 14.84）。这些MER启动标准的似然比与应用最极端1%生命体征阈值时得出的似然比相似。
本研究表明，澳大利亚指南中的生命体征以及升级至MER启动能够适当地预测南澳大利亚普通外科服务收治的一大群患者的院内死亡率。
