Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Quality & Safety, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA.
Acad Emerg Med. 2024 Mar;31(3):210-219. doi: 10.1111/acem.14821. Epub 2023 Nov 3.
Vital signs are a critical component of the prehospital assessment. Prior work has suggested that vital signs may vary in their distribution by age. These differences in vital signs may have implications on in-hospital outcomes or be utilized within prediction models. We sought to (1) identify empirically derived (unadjusted) cut points for vital signs for adult patients encountered by emergency medical services (EMS), (2) evaluate differences in age-adjusted cutoffs for vital signs in this population, and (3) evaluate unadjusted and age-adjusted vital signs measures with in-hospital outcomes.
We used two multiagency EMS data sets to derive (National EMS Information System from 2018) and assess agreement (ESO, Inc., from 2019 to 2021) of vital signs cutoffs among adult EMS encounters. We compared unadjusted to age-adjusted cutoffs. For encounters within the ESO sample that had in-hospital data, we compared the association of unadjusted cutoffs and age-adjusted cutoffs with hospitalization and in-hospital mortality.
We included 13,405,858 and 18,682,684 encounters in the derivation and validation samples, respectively. Both extremely high and extremely low vital signs demonstrated stepwise increases in admission and in-hospital mortality. When evaluating age-based centiles with vital signs, a gradual decline was noted at all extremes of heart rate (HR) with increasing age. Extremes of systolic blood pressure at upper and lower margins were greater in older age groups relative to younger age groups. Respiratory rate (RR) cut points were similar for all adult age groups. Compared to unadjusted vital signs, age-adjusted vital signs had slightly increased accuracy for HR and RR but lower accuracy for SBP for outcomes of mortality and hospitalization.
We describe cut points for vital signs for adults in the out-of-hospital setting that are associated with both mortality and hospitalization. While we found age-based differences in vital signs cutoffs, this adjustment only slightly improved model performance for in-hospital outcomes.
生命体征是院前评估的重要组成部分。先前的研究表明，生命体征的分布可能因年龄而异。这些生命体征的差异可能对住院结局有影响，或者可用于预测模型中。我们试图：(1)确定急诊医疗服务(EMS)中遇到的成年患者的生命体征的经验性（未调整）切点；(2)评估该人群中生命体征的年龄调整切点的差异；(3)评估未调整和年龄调整的生命体征指标与住院结局的关系。
我们使用两个多机构 EMS 数据集来推导出（2018 年的国家 EMS 信息系统）并评估生命体征切点的一致性（2019 年至 2021 年的 ESO，Inc.）在成年 EMS 接触中。我们比较了未调整和年龄调整的切点。对于 ESO 样本中具有住院数据的接触者，我们比较了未调整的切点和年龄调整的切点与住院和院内死亡率的关系。
我们分别纳入了推导和验证样本中的 13405858 和 18682684 次接触。极高和极低的生命体征均显示出入院和院内死亡率的逐步增加。当用生命体征评估基于年龄的百分位数时，随着年龄的增加，心率（HR）的所有极端值都呈逐渐下降趋势。与年轻年龄组相比，收缩压的上下限极值在年龄较大的年龄组中更大。所有成年年龄组的呼吸率（RR）切点相似。与未调整的生命体征相比，年龄调整的生命体征对 HR 和 RR 的准确性略有提高，但对 SBP 的准确性降低，从而影响死亡率和住院率。
我们描述了院外环境中成年人生命体征的切点，这些切点与死亡率和住院率都有关。虽然我们发现生命体征切点存在基于年龄的差异，但这种调整仅略微提高了住院结局的模型性能。
