Mathur R, Clark R A, Dhillon D P, Winter J H, Lipworth B J
Department of Respiratory Medicine, King's Cross Hospital Dundee.
Scott Med J. 1997 Apr;42(2):49-52. doi: 10.1177/003693309704200208.
Subsequent to the implementation of a severity marker stamp in case notes, an audit was performed in 86 admissions with acute asthma to a specialist centre over a 12 month period. Compared to previous audit the documentation of severity markers was significantly better (PEFR: 52% vs 83% p = 0.001, Respiratory rate: 44% vs 81% p = 0.001, ABG: 72% vs 80% p = 0.04, air entry: 58% vs 86% p = 0.001, speech: 27% vs 86% p = 0.001, exhaustion: 4% vs 86% p = 0.001). In contrast to the previous audit where no patient received FiO2 > 0.35, 66% of the cases in the repeat audit received FiO2 0.60 (p = 0.001). The mean duration of admission was five days and showed highest partial correlation (r = 0.6) to the time in hours for the pulse to fall to 80/min. Multiple linear regression showed that this was the only variable best predicting the duration of admission (R2 = 0.3). Admission pulse rate (p = 0.04) and serum K+ (p = 0.04) best discriminated between patients admitted for over and under five days. Logistic regression identified only the admission pulse as significant in calculating the odds of the patient staying in the hospital for > 5 days.
在病例记录中实施严重程度标记印章后，在12个月期间对一家专科中心收治的86例急性哮喘患者进行了审计。与之前的审计相比，严重程度标记的记录明显更好（呼气峰值流速：52%对83%，p = 0.001；呼吸频率：44%对81%，p = 0.001；动脉血气分析：72%对80%，p = 0.04；呼吸音：58%对86%，p = 0.001；言语：27%对86%，p = 0.001；疲惫：4%对86%，p = 0.001）。与之前审计中没有患者接受>0.35的吸入氧分数相反，重复审计中有66%的病例接受了0.60的吸入氧分数（p = 0.001）。平均住院时间为5天，与脉搏降至80次/分钟的小时数显示出最高的偏相关性（r = 0.6）。多元线性回归表明，这是唯一能最好预测住院时间的变量（决定系数R2 = 0.3）。入院时的脉搏率（p = 0.04）和血清钾（p = 0.04）在区分住院时间超过和不足5天的患者方面表现最佳。逻辑回归表明，在计算患者住院>5天的几率时，只有入院时的脉搏具有显著性。
