Waheed Shahan, Razzak Junaid Abdul, Khan Nadeem Ullah, Raheem Ahmed, Mian Asad Iqbal
Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
Department of Emergency Medicine, New York Presbyterian Weill Cornell Medicine, New York, USA.
Emerg Med Int. 2024 Apr 23;2024:6600829. doi: 10.1155/2024/6600829. eCollection 2024.
Critically ill patients have increased risk of cardiovascular collapse following endotracheal intubation due to physiological instability. This study aims to validate the Difficult Airway Physiological Score (DAPS) in adults to predict the risk of serious outcomes in the emergency department of a tertiary care private hospital.
This is a cohort study conducted in the emergency department (ED) from 2021 to 2022. Difficult Airway Physiological Score (DAPS) was derived from a sample of 1021 patients through a retrospective study. The variables in the score were age, gender, time of intubation, vitals and vomiting at presentation, pH <7.3, fever, physician's anticipation for patient decline, and agitation. The model performance was assessed prospectively on a separate dataset ( = 326) using train-test split method. Postintubation desaturation, hypotension, cardiac arrest, and mortality postintubation were the serious outcomes. ROC analysis, sensitivity, specificity, PPV, and NPV were used to assess score validity.
Our study includes 326 patients, of which 123 (37.7%) were males and 203 (62.2%) were females. The sample was divided into high-risk (DAPS ≥10) group, = 194 with mean age of 52 (SD = ±18) years, and low-risk (DAPS <10) group, = 132 with mean age of 47.7 (SD = ±17.4) years. The shock index ≥0.9 was in 128 (66%), while it was <0.9 in low-risk = 111 (84%), value <0.001. Similarly, pH <7.3 was seen in 70 (36.1%) in high-risk group compared to 4 (3%) in low-risk group, value <0.001. Cardiac arrest was observed in 56 (17.2%) patients, of which 45 (23.2%) were in high-risk and 11 (8.3%) in low-risk groups ( < 0.001). Hypotension was the primary outcome in the high-risk group 100 (51.5%) versus 32 (24.2%) in low-risk group ( < 0.001). The DAPS of 10 had an area under the curve of 0.865 (0.71-0.84). The sensitivity of DAPS was 78.5%, specificity 77.9%, and accuracy 78.2%.
The score can accurately predict serious outcomes in critically ill adult patients with physiologically difficult airway demonstrating good sensitivity and specificity.
由于生理不稳定，重症患者在气管插管后发生心血管衰竭的风险增加。本研究旨在验证成人困难气道生理评分（DAPS），以预测三级护理私立医院急诊科严重后果的风险。
这是一项于2021年至2022年在急诊科进行的队列研究。通过回顾性研究从1021例患者样本中得出困难气道生理评分（DAPS）。该评分中的变量包括年龄、性别、插管时间、就诊时的生命体征和呕吐情况、pH<7.3、发热、医生对患者病情恶化的预期以及躁动情况。使用训练-测试分割方法在一个单独的数据集（n=326）上对模型性能进行前瞻性评估。插管后低氧血症、低血压、心脏骤停和插管后死亡率是严重后果。采用ROC分析、敏感性、特异性、阳性预测值和阴性预测值来评估评分的有效性。
我们的研究包括326例患者，其中123例（37.7%）为男性，203例（62.2%）为女性。样本分为高危（DAPS≥10）组，n=194，平均年龄52岁（标准差=±18）；低危（DAPS<10）组，n=132，平均年龄47.7岁（标准差=±17.4）。高危组中休克指数≥0.9的有128例（66%），而低危组中该指数<0.9的有111例（84%），P值<0.001。同样，高危组中pH<7.3的有70例（36.1%），而低危组中只有4例（3%），P值<0.001。观察到56例（17.2%）患者发生心脏骤停，其中高危组45例（23.2%），低危组11例（8.3%）（P<0.001）。低血压是高危组的主要结局，有100例（51.5%），而低危组有32例（24.2%）（P<0.001）。DAPS为10时曲线下面积为0.865（0.71-0.84）。DAPS的敏感性为78.5%，特异性为77.9%，准确性为78.2%。
该评分能够准确预测气道生理困难的重症成年患者的严重后果，具有良好的敏感性和特异性。
