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院内心脏骤停前的生理恶化：国家早期预警评分-2遗漏了什么？

Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?

作者信息

Gonem Sherif, Draicchio Daniella, Mohamed Ayad, Wood Sally, Shiel Kelly, Briggs Steve, McKeever Tricia M, Shaw Dominick

机构信息

Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.

NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.

出版信息

Resusc Plus. 2024 Sep 30;20:100788. doi: 10.1016/j.resplu.2024.100788. eCollection 2024 Dec.

DOI:10.1016/j.resplu.2024.100788
PMID:39403088
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11472090/
Abstract

AIM

To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA).

METHODS

We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place.

RESULTS

Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement.

CONCLUSIONS

A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.

摘要

目的

确定国家早期预警评分-2（NEWS-2）未能检测到院内心脏骤停（IHCA）前生理状态恶化的频率。

方法

我们对2019年7月1日至2021年12月31日期间在英国城市中心的两家大型急症医院发生院内心脏骤停的所有成年患者（年龄≥18岁）进行了一项回顾性观察研究。检查院内心脏骤停事件发生前一段时间的临床观察结果和病例记录，以确定是否有生理状态恶化的证据表明需要对患者进行紧急评估，NEWS-2是否触发，以及是否实际进行了紧急评估。

结果

在126/374例（33.7%）院内心脏骤停病例发生前需要进行紧急评估，其中20例（15.9%）NEWS-2未触发。在NEWS-2触发的89/106例（84.0%）病例以及未触发的13/20例（65.0%）病例中进行了紧急评估，比例差异具有统计学意义（p = 0.048）。NEWS-2未检测到生理状态恶化的病例中有一半与新出现或升高的氧需求有关。

结论

很大一部分院内心脏骤停事件发生前存在重要生命体征异常，而NEWS-2未能检测到。这可能是一些抢救失败事件的一个致病因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb3/11472090/792fd5d71334/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb3/11472090/5dccc7ada3a2/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb3/11472090/792fd5d71334/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb3/11472090/5dccc7ada3a2/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb3/11472090/792fd5d71334/gr2.jpg

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本文引用的文献

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BMJ Open Respir Res. 2024 Jan 31;11(1):e002095. doi: 10.1136/bmjresp-2023-002095.
2
Evaluation of NEWS2 response thresholds in a retrospective observational study from a UK acute hospital.在英国一家急性医院的回顾性观察研究中评估 NEWS2 反应阈值。
BMJ Open. 2022 Feb 8;12(2):e054027. doi: 10.1136/bmjopen-2021-054027.
3
A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows.
一种根据不同截断值和预测窗口预测国家早期预警评分的歧视和绝对死亡率的系统评价。
Eur J Intern Med. 2022 Apr;98:15-26. doi: 10.1016/j.ejim.2021.12.024. Epub 2021 Dec 31.
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The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours.第五生命体征？护士的担忧预示着患者在24小时内病情恶化。
JAMIA Open. 2019 Aug 28;2(4):465-470. doi: 10.1093/jamiaopen/ooz033. eCollection 2019 Dec.
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The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest.院内心脏骤停前异常生命体征的发生率及意义。
Resuscitation. 2016 Jan;98:112-7. doi: 10.1016/j.resuscitation.2015.08.016. Epub 2015 Sep 9.