Seitz-Rasmussen H E Sebastian, Føns-Sønderskov Morten, Kodal Anne-Marie, Bestle Morten H
Department of Anesthesiology and Intensive Care Copenhagen University Hospital, North Zealand Hilleroed Denmark.
Health Sci Rep. 2024 May 1;7(5):e1754. doi: 10.1002/hsr2.1754. eCollection 2024 May.
Vital sign monitoring needs to be timely and correct to recognize deteriorating patients early and trigger the relevant clinical response. The aim of this study is to retrospectively evaluate compliance specifically toward the regional vital sign monitoring protocol the so called early warning score protocol (EWS-protocol) 72 h before a medical emergency team response (MET-response) and thereby illuminate whether poor compliance translates into a worse patient outcome.
It was investigated all eligible patients that underwent MET responses during the calendar year 2019. The inclusion criteria encompassed somatic patients above 18 years of age admitted to the hospital and detailed evaluations of the medical records of the included patients were conducted.
Four hundred and twenty-nine MET-responses were included in the final analysis. EWS-protocol failure was observed for more than half the patients within all the time frames assessed. Thirty-day mortality was significantly higher for patients subject to EWS protocol failure in the timeframes 24-16, 16-8, 8-0 h before MET response. Adjusting for admission length, age, and gender, patients subject to EWS-protocol failure had an odds ratio (OR) of 1.9, 2.0, 2.1, 2.3 for mortality in the time frames 72-48, 24-16, 16-8, and 8-0 h before the MET-response, respectively. The adjusted OR for ICU-admission was 1.7, and 1.6 for patients subject to EWS-protocol failure in the time frames 16-8 and 8-0 h before MET-response, respectively.
According to all the data analysis in this article, there is evidence that compliance toward the NEWS-protocol is poor. EWS-protocol failure is associated with a significant higher mortality and ICU-admission rate.
生命体征监测需要及时且准确，以便尽早识别病情恶化的患者并触发相关临床反应。本研究的目的是回顾性评估在医疗急救团队响应（MET响应）前72小时对区域生命体征监测方案（即所谓的早期预警评分方案，EWS方案）的具体依从性，从而阐明依从性差是否会导致更差的患者预后。
对2019年日历年期间接受MET响应的所有符合条件的患者进行调查。纳入标准包括18岁以上入住医院的躯体疾病患者，并对纳入患者的病历进行详细评估。
最终分析纳入了429次MET响应。在所有评估的时间范围内，超过一半的患者观察到EWS方案未达标。在MET响应前24 - 16小时、16 - 8小时、8 - 0小时时间范围内，EWS方案未达标的患者30天死亡率显著更高。在调整入院时长、年龄和性别后，在MET响应前72 - 48小时、24 - 16小时、16 - 8小时和8 - 0小时时间范围内，EWS方案未达标的患者死亡比值比（OR）分别为1.9、2.0、2.1、2.3。在MET响应前16 - 8小时和8 - 0小时时间范围内，EWS方案未达标的患者入住重症监护病房（ICU）的调整后OR分别为1.7和1.6。
根据本文所有数据分析，有证据表明对NEWS方案的依从性较差。EWS方案未达标与显著更高的死亡率和ICU入住率相关。
