Sivayoham Narani, O'Mara Harriet, Trenchard Turner Natasha, Sysum Katie, Wicks Georgina, Mason Oliver
Department of Emergency Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
Department of Intensive Care Medicine, St George's University Hospitals NHS Foundation Trust, London, UK.
BMJ Open Qual. 2025 Jan 6;14(1):e003054. doi: 10.1136/bmjoq-2024-003054.
Hospitalised patients are at risk of deterioration and death. Delayed identification and transfer to the intensive care unit (ICU) are known to be associated with increased mortality rates. The Risk-stratification of Emergency Department suspected Sepsis (REDS) score was derived and validated in emergency department patients with suspected sepsis. It is unknown if the REDS score would risk-stratify undifferentiated hospitalised patients who deteriorate.
To validate the REDS score in hospitalised patients who deteriorate.
This retrospective cohort single-centre study involved hospitalised adult patients who deteriorated and were transferred to the ICU between 1 April 2022 and 31 March 2023. The first admission to the ICU was studied. The National Early Warning Score2 (NEWS2), REDS, Sequential Organ Failure Assessment (SOFA) and change-in-SOFA (ΔSOFA) scores were calculated at the time of referral to the Critical Care Outreach Team (CCOT). The primary outcome measure was in-hospital all-cause mortality. The area under the receiver operator characteristic (AUROC) curves for the scores were compared. Test characteristics at the cut-off points individually and in combination were noted.
Of the 289 patients studied, 91 died. The REDS score had the largest AUROC curve at 0.70 (95% CI 0.65 to 0.75), greater than the NEWS2 score at 0.62 (95% CI 0.56 to 0.68), p=0.03, and similar to the SOFA score 0.67 (95% CI 0.61 to 0.72), p=0.3. The cut-off points for the NEWS2, REDS, SOFA and ΔSOFA scores were >9, >3, >6 and >4, respectively. The sensitivity and specificity for a ΔSOFA≥2 was 91.2% (95% CI 83.4 to 96.1) and 15.7% (95% CI 10.9 to 21.5), respectively. REDS≥4 or NEWS2≥7 had a sensitivity of 87.9% (95% CI 79.4 to 93.8) and specificity of 29.3% (95% CI 23.1 to 36.2).
The prognostic performance of the REDS score was similar to the SOFA score, but greater than the NEWS2 score. The REDS score could be used in addition to the established NEWS2 score to risk-stratify hospitalised patients for mortality.
住院患者存在病情恶化和死亡风险。已知识别延迟及转入重症监护病房（ICU）延迟与死亡率增加相关。急诊科疑似脓毒症风险分层（REDS）评分已在急诊科疑似脓毒症患者中得出并验证。尚不清楚REDS评分是否能对病情恶化的未分化住院患者进行风险分层。
验证REDS评分在病情恶化的住院患者中的有效性。
这项回顾性队列单中心研究纳入了2022年4月1日至2023年3月31日期间病情恶化并转入ICU的成年住院患者。研究首次入住ICU的情况。在转诊至重症监护外展团队（CCOT）时计算国家早期预警评分2（NEWS2）、REDS、序贯器官衰竭评估（SOFA）和SOFA变化值（ΔSOFA）评分。主要结局指标为院内全因死亡率。比较各评分的受试者工作特征（AUROC）曲线下面积。记录各切点单独及联合时的检验特征。
在研究的289例患者中，91例死亡。REDS评分的AUROC曲线最大，为0.70（95%可信区间0.65至0.75），大于NEWS2评分的0.62（95%可信区间0.56至0.68），p = 0.03，与SOFA评分的0.67（95%可信区间0.61至0.72）相似，p = 0.3。NEWS2、REDS、SOFA和ΔSOFA评分的切点分别>9、>3、>6和>4。ΔSOFA≥2时的敏感性和特异性分别为91.2%（95%可信区间83.4至96.1）和15.7%（95%可信区间10.9至21.5）。REDS≥4或NEWS2≥7时的敏感性为87.9%（95%可信区间79.4至93.8），特异性为29.3%（95%可信区间23.1至36.2）。
REDS评分的预后性能与SOFA评分相似，但优于NEWS2评分。REDS评分可在已有的NEWS2评分基础上，用于对住院患者进行死亡风险分层。
