Tomás Esmael, Escoval Ana, Antunes Maria Lina
Faculty of Medicine of the University Agostinho Neto, Angola-Av. Hoji-Ya-HendaQuintalão do Hospital Américo Boavida, Luanda, Angola.
NOVA National School of Public Health NOVA University of Lisbon, Portugal-Av. Padre Cruz, Lisboa 1600-560, Portugal.
Crit Care Res Pract. 2024 Sep 23;2024:9070807. doi: 10.1155/2024/9070807. eCollection 2024.
Nearly 30 years since its inception, the early warning scores (EWSs) remain pivotal, yet variations have emerged for hospital and prehospital use. Aggregated scores, reflecting multiple physiological parameters, outperform single-parameter systems in assessing acute illness severity, though consensus on optimal approaches is lacking. Resource-limited countries, including Angola, lack adapted EWSs, emphasizing the need for cost-effective and adaptable solutions to enhance patient care. To explore the perspectives of Angolan experts to identify physiological parameters suitable for incorporation into existing EWSs, allowing the development of a new tool adjusted to the healthcare context in Angola. We conducted a three-round Delphi survey, engaging a national expert panel comprising twenty-five physicians and nurses with expertise in internal medicine, surgery, emergency rooms, intensive care units, and/or teachers at universities or at teaching courses in these fields. Participants were asked to rate items using a five-point Likert scale. Consensus was achieved if the items received a rating ≥ 80% from the panel. Consensus was evident for the inclusion of standard physiological parameters, such as systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, neurological status, and the presence or absence of supplemental oxygen. Furthermore, there was consensus for the consideration of specific items, namely, seizures, jaundice, cyanosis, capillary refill time, and pain-typically not included in the current EWSs. Consensus was reached regarding the exclusion of both oxygen saturation and temperature measurements in healthcare settings where oximeters and thermometers might not be readily available. Angolan experts were able to identify the physiological parameters suitable for incorporation into the basic EWSs. Further study must be conducted to test and validate the impact of the newly suggested vital parameters on the discriminant and predictive capability of a new aggregated model specifically adjusted to the Angolan healthcare setting.
自早期预警评分（EWS）问世近30年来，它仍然至关重要，但在医院和院前使用中出现了多种变体。综合评分反映了多个生理参数，在评估急性疾病严重程度方面优于单参数系统，不过对于最佳方法尚未达成共识。包括安哥拉在内的资源有限国家缺乏适用的EWS，这凸显了需要具有成本效益且适应性强的解决方案来改善患者护理。为了探索安哥拉专家的观点，以确定适合纳入现有EWS的生理参数，从而开发一种根据安哥拉医疗环境调整的新工具。我们进行了三轮德尔菲调查，参与的国家专家小组由25名医生和护士组成，他们在内科、外科、急诊室、重症监护病房方面具有专业知识，和/或在这些领域的大学或教学课程中担任教师。要求参与者使用五点李克特量表对项目进行评分。如果项目获得小组≥80%的评分，则达成共识。对于纳入标准生理参数，如收缩压、心率、呼吸频率、体温、血氧饱和度、神经状态以及是否使用补充氧气，达成了共识。此外，对于考虑特定项目也达成了共识，即癫痫发作、黄疸、发绀、毛细血管再充盈时间和疼痛——这些通常不包括在当前的EWS中。对于在可能无法轻易获得血氧仪和温度计的医疗环境中排除血氧饱和度和体温测量达成了共识。安哥拉专家能够确定适合纳入基本EWS的生理参数。必须进行进一步研究，以测试和验证新建议的生命体征参数对专门针对安哥拉医疗环境调整的新综合模型的判别和预测能力的影响。
