Stolze Annick, Vernooij Lisette, de Korte-de Boer Dianne, Hollmann Markus W, Buhre Wolfgang F F A, Boer Christa, Noordzij Peter G
Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Department Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Perioper Med (Lond). 2025 Apr 1;14(1):39. doi: 10.1186/s13741-025-00516-w.
Early warning system (EWS) scores are implemented on surgical wards to identify patients at high risk of postoperative clinical deterioration, but its predictive value in older patients is unclear. This study assessed the prognostic value of EWS scores to predict severe postoperative complications in older patients compared to younger patients.
This study utilized data from the TRACE study. EWS scores were routinely measured on postoperative days one (POD1) and three (POD3). The cohort was divided by age: < 70 years and ≥ 70 years. Performance measures of EWS scores on POD1 and POD3 were assessed to predict severe postoperative complications. Missed event rates (proportion of events not detected by the EWS threshold) and nonevent rates (proportion of EWS values above the threshold without an adverse event) were calculated.
Among 4866 patients, 39.3% were ≥ 70 years old. Severe complications occurred in 6.1% of older compared to 5.8% of younger patients (P = 0.658). EWS scores on POD1 and POD3 did not differ between age groups. For severe complications, EWS showed moderate discrimination in both older (POD1: C-statistic 0.65 (95%CI 0.59-0.70); POD3: 0.63 (95%CI 0.57-0.69)) and younger patients (POD1: 0.68 (95%CI 0.65-0.72); POD3: 0.65 (95%CI 0.61-0.70)). Overall, calibration was good. For EWS score ≥ 3, the missed event rate was at least 69% and nonevent rate 75%.
Predicted performance of the EWS score was moderate among older and younger patients. A limitation of the EWS score is the high rate of missed events and nonevents.
手术病房采用早期预警系统（EWS）评分来识别术后临床病情恶化风险较高的患者，但其在老年患者中的预测价值尚不清楚。本研究评估了EWS评分与年轻患者相比，对预测老年患者术后严重并发症的预后价值。
本研究使用了TRACE研究的数据。在术后第1天（POD1）和第3天（POD3）常规测量EWS评分。根据年龄将队列分为：<70岁和≥70岁。评估POD1和POD3时EWS评分的性能指标，以预测术后严重并发症。计算漏诊事件率（EWS阈值未检测到的事件比例）和无事件率（EWS值高于阈值且无不良事件的比例）。
在4866例患者中，39.3%的患者年龄≥70岁。老年患者中严重并发症的发生率为6.1%，而年轻患者为5.8%（P = 0.658）。POD1和POD3时的EWS评分在不同年龄组之间没有差异。对于严重并发症，EWS在老年患者（POD1：C统计量0.65（95%CI 0.59 - 0.70）；POD3：0.63（95%CI 0.57 - 0.69））和年轻患者（POD1：0.68（95%CI 0.65 - 0.72）；POD3：0.65（95%CI 0.61 - 0.70））中均显示出中等区分能力。总体而言，校准良好。对于EWS评分≥3，漏诊事件率至少为69%，无事件率为75%。
EWS评分在老年和年轻患者中的预测性能中等。EWS评分的一个局限性是漏诊事件和无事件的发生率较高。
