Ramgopal Sriram, Callaway Clifton W, Martin-Gill Christian, Okubo Masashi
Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IllinoisUSA.
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaUSA.
Prehosp Disaster Med. 2025 Jun;40(3):129-135. doi: 10.1017/S1049023X25001542. Epub 2025 May 22.
Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.
The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).
A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.
Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).
Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.
生命体征是应急响应系统和大规模伤亡灾难事件中对患者进行院前评估的重要组成部分。目前用于定义有意义的生命体征范围以预测高级护理需求的数据有限。
本研究的目的是确定在紧急医疗服务（EMS）护理的成年人中，最能预测需要进行挽救生命干预（LSI）的生命体征范围。
对2022年国家紧急医疗服务信息系统（NEMSIS）数据集中由高级生命支持（ALS）提供者送往医院的成人院前病例进行回顾性研究。结果是进行LSI，这是一种综合指标，包括关键气道、药物和程序性干预，分为11组：快速心律失常、心脏骤停、气道、癫痫/镇静、中毒、心动过缓、气道异物清除、血管活性药物、出血控制、针减压和低血糖。在训练分区（75%）中进行切点选择，以确定心率（HR）、呼吸频率（RR）、收缩压（SBP）、血氧饱和度和格拉斯哥昏迷量表（GCS）的范围，采用旨在优先考虑特异性的方法，将敏感性限制在至少25%。
在纳入的18259766例病例中（中位年龄63岁；51.8%为男性），6.3%至少接受过一次LSI，最常见的是气道干预（2.2%）。生命体征的最佳范围包括HR为47 - 129次/分钟、RR为8 - 30次/分钟、SBP为96 - 180mmHg、血氧饱和度>93%、GCS>13。在测试分区中，异常生命体征的敏感性为75.1%，特异性为66.6%，阳性预测值（PPV）为12.5%。包含所有生命体征的多变量模型显示受试者工作特征曲线下面积（AUROC）为0.78（95%置信区间[CI]，0.78 - 0.78）。生命体征在识别需要气道管理（0.85）、针减压（0.84）和快速心律失常（0.84）的病例时准确性更高，而在出血控制（0.52）、低血糖管理（0.68）和异物清除（0.69）方面准确性较低。
院前环境中成人生命体征的最佳范围是通过统计学方法得出的。这些范围可能有助于院前方案和医疗警报系统，或者可纳入预测模型中，以识别院外紧急情况患者中的重症和/或受伤患者。
