Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
J Clin Nurs. 2024 Aug;33(9):3565-3575. doi: 10.1111/jocn.17029. Epub 2024 Feb 14.
To develop and internally validate risk prediction models for subsequent clinical deterioration, unplanned ICU admission and death among ward patients following medical emergency team (MET) review.
A retrospective cohort study of 1500 patients who remained on a general ward following MET review at an Australian quaternary hospital.
Logistic regression was used to model (1) subsequent MET review within 48 h, (2) unplanned ICU admission within 48 h and (3) hospital mortality. Models included demographic, clinical and illness severity variables. Model performance was evaluated using discrimination and calibration with optimism-corrected bootstrapped estimates. Findings are reported using the TRIPOD guideline for multivariable prediction models for prognosis or diagnosis. There was no patient or public involvement in the development and conduct of this study.
Within 48 h of index MET review, 8.3% (n = 125) of patients had a subsequent MET review, 7.2% (n = 108) had an unplanned ICU admission and in-hospital mortality was 16% (n = 240). From clinically preselected predictors, models retained age, sex, comorbidity, resuscitation limitation, acuity-dependency profile, MET activation triggers and whether the patient was within 24 h of hospital admission, ICU discharge or surgery. Models for subsequent MET review, unplanned ICU admission, and death had adequate accuracy in development and bootstrapped validation samples.
Patients requiring MET review demonstrate complex clinical characteristics and the majority remain on the ward after review for deterioration. A risk score could be used to identify patients at risk of poor outcomes after MET review and support general ward clinical decision-making.
Our risk calculator estimates risk for patient outcomes following MET review using clinical data available at the bedside. Future validation and implementation could support evidence-informed team communication and patient placement decisions.
开发并内部验证医疗应急团队（MET）审查后，病房患者随后临床恶化、非计划转入 ICU 和死亡的风险预测模型。
这是一项在澳大利亚四级医院对接受 MET 审查后仍留在普通病房的 1500 名患者进行的回顾性队列研究。
使用逻辑回归对以下内容进行建模：(1) 在 48 小时内进行后续 MET 审查，(2) 在 48 小时内非计划转入 ICU，以及 (3) 医院死亡率。模型纳入了人口统计学、临床和疾病严重程度变量。使用校正后的 Bootstrap 估计值进行了模型的区分度和校准度评估。结果根据用于预后或诊断的多变量预测模型的 TRIPOD 指南进行报告。在该研究的开发和进行过程中，未涉及患者或公众参与。
在指数 MET 审查后的 48 小时内，8.3%（n=125）的患者进行了后续 MET 审查，7.2%（n=108）非计划转入 ICU，住院死亡率为 16%（n=240）。从临床预选预测因子中，模型保留了年龄、性别、合并症、复苏限制、急性依赖程度、MET 激活触发因素以及患者是否在入院后 24 小时内、ICU 出院或手术后。后续 MET 审查、非计划 ICU 入院和死亡的模型在开发和 Bootstrap 验证样本中具有足够的准确性。
需要进行 MET 审查的患者表现出复杂的临床特征，大多数患者在审查后仍留在病房，病情恶化。风险评分可用于识别 MET 审查后预后不良的风险患者，并支持普通病房的临床决策。
我们的风险计算器使用床边可用的临床数据估算 MET 审查后患者结局的风险。未来的验证和实施可以支持循证团队沟通和患者安置决策。
