Widely used track and trigger scores: Are they ready for automation in practice?

RESUSCITATION

卷:85

Article

Romero-Brufau, Santiago¹  Huddleston, Jeanne M.^1,2,3  Naessens, James M.^1,3  Johnson, Matthew G.^1,3  Hickman, Joel^1,3  Morlan, Bruce W.^1,3  Jensen, Jeffrey B.⁴  Caples, Sean M.⁵  Elmer, Jennifer L.⁶  Schmidt, Julie A.⁶  Morgenthaler, Timothy I.⁵  Santrach, Paula J.⁷ 

[1] Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA

[2] Mayo Clin, Div Hosp Internal Med, Rochester, MN 55905 USA

[3] Mayo Clin, Div Hlth Care Policy & Res, Rochester, MN 55905 USA

[4] Mayo Clin, Dept Anesthesiol, Rochester, MN 55905 USA

[5] Mayo Clin, Div Pulm Med & Crit Care, Rochester, MN 55905 USA

[6] Mayo Clin, Dept Nursing, Rochester, MN 55905 USA

[7] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55905 USA

关键词: Early warning score;    Track-and-trigger;    Rapid response system;    Automation;    Patient safety;    Cardiorespiratory arrests;   

DOI  :  10.1016/j.resuscitation.2013.12.017

来源: Elsevier

【 摘 要 】

Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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