BACKGROUND: Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with late signs (LS) with in-hospital death. METHODS: A cross-sectional survey was undertaken of 3046 non-do not attempt resuscitation adult admissions in 5 hospitals without MET over 14 days. The medical records were reviewed for recordings of 26 ES and 21 LS and in-hospital death. Combinations of ES with or without LS were examined as predictors of death. Global modified early warning scores (GMEWS) were calculated. FINDINGS: ES with LS, plus LS only, had higher odd ratios than ES alone. Four combinations of ES were strongly associated with death: cardiovascular plus respiratory with decrease in urinary output, cardiovascular plus respiratory with a decrease in consciousness, respiratory with decrease in urinary output, and cardiovascular plus respiratory. In other combinations, recordings of SpO2 90-95%, systolic blood pressure 80-100 mmHg or decrease in urinary output in turn occurring with one or more disturbed blood gas variable were associated with death. Compared with admissions whose GMEWS were 0-2, admissions with GMEWS 5-15 were 27.1 times more likely to die while those with GMEWS 3-4 were 6.5 times more likely. CONCLUSIONS: The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria.
BACKGROUND: Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with late signs (LS) with in-hospital death. METHODS: A cross-sectional survey was undertaken of 3046 non-do not attempt resuscitation adult admissions in 5 hospitals without MET over 14 days. The medical records were reviewed for recordings of 26 ES and 21 LS and in-hospital death. Combinations of ES with or without LS were examined as predictors of death. Global modified early warning scores (GMEWS) were calculated. FINDINGS:ES with LS, plus LS only, had higher odd ratios than ES alone. Four combinations of ES were strongly associated with death: cardiovascular plus respiratory with decrease in urinary output, cardiovascular plus respiratory with a decrease in consciousness, respiratory with decrease in urinary output, and cardiovascular plus respiratory. In other combinations, recordings of SpO2 90-95%, systolic blood pressure 80-100 mmHg or decrease in urinary output in turn occurring with one or more disturbed blood gas variable were associated with death. Compared with admissions whose GMEWS were 0-2, admissions with GMEWS 5-15 were 27.1 times more likely to die while those with GMEWS 3-4 were 6.5 times more likely. CONCLUSIONS: The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria.
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: Joaquim Michael Havens; Alexandra B Columbus; Anupamaa J Seshadri; Carlos V R Brown; Gail T Tominaga; Nathan T Mowery; Marie Crandall Journal: Trauma Surg Acute Care Open Date: 2018-04-29
Authors: Pia Hubner; Andreas Schober; Fritz Sterz; Peter Stratil; Christian Wallmueller; Christoph Testori; Daniel Grassmann; Nitaya Lebl; Iris Ohrenberger; Harald Herkner; Chirstoph Weiser Journal: Medicine (Baltimore) Date: 2015-12 Impact factor: 1.817