OBJECTIVE: To make a preliminary estimation of the workload for a medical emergency team (MET) in a Scandinavian University Hospital by recording prevalent physiological data on all adult patients and to see if the patients with deviating physiology (i.e. fulfilling the study criteria, in essence a set of simplified MET-criteria) had an elevated mortality. We also tested sensitivity and specificity by altering the cut-off levels of the calling criteria. DESIGN: Cross sectional prevalence study. SETTING: University hospital in the capital of Sweden. PATIENTS: Adult patients treated in the general wards of the hospital. Patients from psychiatric wards and intensive care units were excluded from the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 4.5% of the scored patients fulfilled the study criteria. These patients had a 30-day mortality of 25% (confidence interval 12.7-41.2) as compared to 3.5% (2.4-5) for the patients not fulfilling the study criteria. Extended criteria revealed 18 deaths within 30 days, 8 more deaths than the original study criteria. However, 123 patients - equalling 13.8% of the cohort (CI 11.6-16.2) - fulfilled these criteria as compared to the 40 patients fulfilling the original study criteria. Thus, the 30-day mortality of the patients with positive extended criteria totalled 14.6% (CI 8.9-22.1). Restricted criteria showed a mere 20 patients (2.2%; CI 1.4-3.5) and only 4 deaths, making 30-day mortality 20% (CI 5.7-43.7); thus, sensitivity was actually lower using restricted criteria. CONCLUSIONS: Even these modified - and simplified - MET-criteria proved to be able to single out patients with elevated mortality as compared to the rest of the hospital population. Extending the criteria significantly lowered sensitivity and would extend the MET-workload enormously. Restricting the criteria led to missed mortalities where intervention could be beneficial. The results suggest that a routine use of simple physiological tests can be of help in the identification of patients at risk.
OBJECTIVE: To make a preliminary estimation of the workload for a medical emergency team (MET) in a Scandinavian University Hospital by recording prevalent physiological data on all adult patients and to see if the patients with deviating physiology (i.e. fulfilling the study criteria, in essence a set of simplified MET-criteria) had an elevated mortality. We also tested sensitivity and specificity by altering the cut-off levels of the calling criteria. DESIGN: Cross sectional prevalence study. SETTING: University hospital in the capital of Sweden. PATIENTS: Adult patients treated in the general wards of the hospital. Patients from psychiatric wards and intensive care units were excluded from the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 4.5% of the scored patients fulfilled the study criteria. These patients had a 30-day mortality of 25% (confidence interval 12.7-41.2) as compared to 3.5% (2.4-5) for the patients not fulfilling the study criteria. Extended criteria revealed 18 deaths within 30 days, 8 more deaths than the original study criteria. However, 123 patients - equalling 13.8% of the cohort (CI 11.6-16.2) - fulfilled these criteria as compared to the 40 patients fulfilling the original study criteria. Thus, the 30-day mortality of the patients with positive extended criteria totalled 14.6% (CI 8.9-22.1). Restricted criteria showed a mere 20 patients (2.2%; CI 1.4-3.5) and only 4 deaths, making 30-day mortality 20% (CI 5.7-43.7); thus, sensitivity was actually lower using restricted criteria. CONCLUSIONS: Even these modified - and simplified - MET-criteria proved to be able to single out patients with elevated mortality as compared to the rest of the hospital population. Extending the criteria significantly lowered sensitivity and would extend the MET-workload enormously. Restricting the criteria led to missed mortalities where intervention could be beneficial. The results suggest that a routine use of simple physiological tests can be of help in the identification of patients at risk.
Authors: Haiyan Gao; Ann McDonnell; David A Harrison; Tracey Moore; Sheila Adam; Kathleen Daly; Lisa Esmonde; David R Goldhill; Gareth J Parry; Arash Rashidian; Christian P Subbe; Sheila Harvey Journal: Intensive Care Med Date: 2007-02-22 Impact factor: 17.440
Authors: Gabriella Jäderling; Paolo Calzavacca; Max Bell; Claes-Roland Martling; Daryl Jones; Rinaldo Bellomo; David Konrad Journal: Intensive Care Med Date: 2011-03-03 Impact factor: 17.440
Authors: Marilyn Hravnak; Michael A Devita; Amy Clontz; Leslie Edwards; Cynthia Valenta; Michael R Pinsky Journal: Crit Care Med Date: 2011-01 Impact factor: 7.598
Authors: Eliezer Bose; Lujie Chen; Gilles Clermont; Artur Dubrawski; Michael R Pinsky; Dianxu Ren; Leslie A Hoffman; Marilyn Hravnak Journal: Respir Care Date: 2017-01-24 Impact factor: 2.258
Authors: Jasmeet Soar; Mary E Mancini; Farhan Bhanji; John E Billi; Jennifer Dennett; Judith Finn; Matthew Huei-Ming Ma; Gavin D Perkins; David L Rodgers; Mary Fran Hazinski; Ian Jacobs; Peter T Morley Journal: Resuscitation Date: 2010-10 Impact factor: 5.262
Authors: David Konrad; Gabriella Jäderling; Max Bell; Fredrik Granath; Anders Ekbom; Claes-Roland Martling Journal: Intensive Care Med Date: 2009-09-16 Impact factor: 17.440
Authors: R Scott Evans; Kathryn G Kuttler; Kathy J Simpson; Stephen Howe; Peter F Crossno; Kyle V Johnson; Misty N Schreiner; James F Lloyd; William H Tettelbach; Roger K Keddington; Alden Tanner; Chelbi Wilde; Terry P Clemmer Journal: J Am Med Inform Assoc Date: 2014-08-27 Impact factor: 4.497