Rural Department of Community Health, La Trobe University, Bendigo, Victoria, Australia
Department of Rural Health, The University of Melbourne, Melbourne, Victoria, Australia.
Emerg Med J. 2024 Jul 22;41(8):481-487. doi: 10.1136/emermed-2023-213708.
The optimal Early Warning System (EWS) scores for identifying patients at risk of clinical deterioration among those transported by ambulance services remain uncertain. This retrospective study compared the performance of 21 EWS scores to predict clinical deterioration using vital signs (VS) measured in the prehospital or emergency department (ED) setting.
Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion. The primary outcome was 30-day mortality; secondary outcomes included 3-day mortality, admission to intensive care or coronary care units, length of hospital stay and emergency call activations. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC). Subanalyses compared the performance of EWS scores between surgical and medical patient types.
Of 1414 patients, 995 (70.4%) (53.1% male, mean age 68.7±17.5 years) were included. In the ED setting, 30-day mortality was best predicted by VitalPAC EWS (AUROC 0.71, 95% CI (0.65 to 0.77)) and National Early Warning Score (0.709 (0.65 to 0.77)). All EWS scores calculated in the prehospital setting had AUROC <0.70. Rapid Emergency Medicine Score (0.83 (0.73 to 0.92)) and New Zealand EWS (0.88 (0.81 to 0.95)) best predicted 3-day mortality in the prehospital and ED settings, respectively. EWS scores calculated using either prehospital or ED VS were more effective in predicting 3-day mortality in surgical patients, whereas 30-day mortality was best predicted in medical patients. Among the EWS scores that achieved AUROC ≥0.70, no statistically significant differences were detected in their discriminatory abilities to identify patients at risk of clinical deterioration.
EWS scores better predict 3-day as opposed to 30-day mortality and are more accurate when estimated using VS measured in the ED. The discriminatory performance of EWS scores in identifying patients at higher risk of clinical deterioration may vary by patient type.
在通过救护车转运的患者中，确定有临床恶化风险的最佳预警系统（EWS）评分仍不确定。本回顾性研究比较了 21 种 EWS 评分在预测使用院前或急诊（ED）环境中测量的生命体征（VS）的临床恶化方面的表现。
2019 年 1 月 1 日至 2019 年 4 月 18 日期间，通过救护车转运至单个 ED 并随后住院的成年患者符合纳入标准。主要结局是 30 天死亡率；次要结局包括 3 天死亡率、入住重症监护病房或冠心病监护病房、住院时间和急诊呼叫激活。使用受试者工作特征曲线下面积（AUROC）评估 EWS 评分的区分能力。亚分析比较了手术和非手术患者类型之间 EWS 评分的表现。
在 1414 名患者中，有 995 名（70.4%）（53.1%为男性，平均年龄 68.7±17.5 岁）被纳入。在 ED 环境中，VitalPAC EWS（AUROC 0.71，95%CI（0.65 至 0.77））和国家早期预警评分（0.709（0.65 至 0.77））对 30 天死亡率的预测效果最佳。在院前环境中计算的所有 EWS 评分的 AUROC<0.70。快速急诊医学评分（0.83（0.73 至 0.92））和新西兰 EWS（0.88（0.81 至 0.95））分别是院前和 ED 环境中预测 3 天死亡率的最佳 EWS 评分。使用院前或 ED VS 计算的 EWS 评分在预测手术患者的 3 天死亡率方面更有效，而在预测内科患者的 30 天死亡率方面效果最佳。在 AUROC≥0.70 的 EWS 评分中，它们识别有临床恶化风险的患者的区分能力没有统计学上的显著差异。
EWS 评分更能预测 3 天而不是 30 天死亡率，并且当使用 ED 中测量的 VS 进行估计时，其准确性更高。EWS 评分在识别临床恶化风险较高的患者方面的区分性能可能因患者类型而异。
