Acute and Critical Care最新文献

{"title":"COVID-19 delirium versus non-COVID-19 delirium in Iran: a computational approach.","authors":"Tina Moghadam Fard, Atiye Sarabi-Jamab, Amirhossein Mohammadi, Nafiseh Sami, Mahdieh Saeidi, Behnam Shariati, Leila Kamalzadeh, Soode Tajik Esmaeeli, Zeynab Yassin, Fatemeh Sadat Mirfazeli","doi":"10.4266/acc.004944","DOIUrl":"10.4266/acc.004944","url":null,"abstract":"<p><strong>Background: </strong>Delirium is an acute condition marked by disturbances in cognition, awareness, and attention, commonly observed in hospitalized patients due to factors such as illness severity and medication. It is particularly prevalent in intensive care unit settings, affecting up to 80% of ventilated patients. This study investigates whether coronavirus disease 2019 (COVID-19) delirium aligns with expectations of non-COVID-19 delirium incidence in other hospitalized patients and identifies unique or common factors contributing to delirium in these groups.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted on 107 hospitalized patients diagnosed with delirium, comprising 56 COVID-19 patients and 51 non-COVID-19 patients. Data were collected through detailed medical record reviews and structured interviews with patients and their caregivers to evaluate factors associated with delirium.</p><p><strong>Results: </strong>The findings revealed a higher prevalence of medication-related stressors in COVID-19 delirium compared to non-COVID-19 delirium. This suggests that overmedication may play a critical role in the development of delirium, regardless of the underlying critical illness condition.</p><p><strong>Conclusions: </strong>This study highlights the significant association between medication stressors and COVID-19 delirium. These findings emphasize the importance of minimizing unnecessary medications and closely monitoring pharmacological treatments to reduce delirium incidence and improve outcomes in hospitalized populations.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"462-472"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low vitamin C concentrations and prognosis in critically ill children.","authors":"Min Jung Kim, Yoon Hee Kim, Soo Yeon Kim, Jong Deok Kim, Mireu Park, Hamin Kim, Myung Hyun Sohn, Kyung Won Kim","doi":"10.4266/acc.000975","DOIUrl":"10.4266/acc.000975","url":null,"abstract":"<p><strong>Background: </strong>The administration of high-dose vitamins has been focused on in critically ill patients as adjunctive therapy for life-threatening conditions. We evaluated the association between serum vitamin C concentrations and patient prognosis.</p><p><strong>Methods: </strong>We retrospectively reviewed and collected clinical and biochemical data, including thiamine and vitamin C levels, of patients admitted to the pediatric intensive care unit (PICU).</p><p><strong>Results: </strong>In total, 177 patients were admitted to the PICU during the study period, and 63 children were enrolled in this study. The most common reason for PICU admission was sepsis (33.3%). The median thiamine and vitamin C levels were 3.6 µg/dl (interquartile range [IQR], 2.9-4.5 µg/dl) and 2.84 µg/ml (IQR, 1.61-4.55 µg/ml), respectively. Thiamine deficiency was observed in 10 patients (15.9%), and 17 (27.0%) had vitamin C deficiency. There were no differences in the vitamin levels according to the reason for PICU admission. Vitamin C levels were affected by nutritional status. The length of stay in the PICU and duration of mechanical ventilation were longer in patients with vitamin C deficiency than in those without (P=0.035 and P=0.010, respectively). The serum delta neutrophil index and C-reactive protein and lactate levels increased in the vitamin C-deficient group (P=0.028 and P=0.039, respectively). There was a significant difference in Pediatric Index of Mortality 3 scores according to vitamin C levels but not in mortality directly.</p><p><strong>Conclusions: </strong>Vitamin C deficiency was associated with elevated inflammatory marker levels, increased mechanical ventilation durations, and PICU admission. Our results support the potential benefits of vitamin C administration in critically ill children.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"482-490"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial arterial pH predicts survival of out-of-hospital cardiac arrest in South Korea.","authors":"Daun Jeong, Sang Do Shin, Tae Gun Shin, Gun Tak Lee, Jong Eun Park, Sung Yeon Hwang, Jin-Ho Choi","doi":"10.4266/acc.001050","DOIUrl":"10.4266/acc.001050","url":null,"abstract":"<p><strong>Background: </strong>Arterial pH reflects both metabolic and respiratory distress in cardiac arrest and has prognostic implications. However, it was excluded from the 2024 update of the Utstein out-of-hospital cardiac arrest (OHCA) registry template. We investigated the rationale for including arterial pH into models predicting clinical outcomes.</p><p><strong>Methods: </strong>Data were sourced from the Korean Cardiac Arrest Research Consortium, a nationwide OHCA registry (NCT03222999). Prediction models were constructed using logistic regression, random forest, and eXtreme Gradient Boosting frameworks. Each framework included three model types: pH, low-flow time, and combined models. Then the area under the receiver operating characteristic curve (AUROC) of each predicting model was compared. The primary outcome was 30- day death or neurologically unfavorable status (cerebral performance category ≥3).</p><p><strong>Results: </strong>Among the 15,765 patients analyzed, 92.2% experienced death or unfavorable neurological outcomes. The predicting performance of the models including pH (AUROC, 0.92-0.94) were comparable to the models including low-flow time in all frameworks (0.93-0.94) (all P>0.05). Inclusion of pH into low-flow time models consistently showed higher AUROCs than individual models in all frameworks (AUROC, 0.93-0.95; all P<0.05).</p><p><strong>Conclusions: </strong>The predicting performance of models including arterial pH was comparable to models including low-flow time, and addition of arterial pH into low-flow time models could increase the performance of the models. Key Words: blood pH; hydrogen-ion con.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"444-451"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating resting energy expenditure in critically ill patients: a retrospective exploratory comparison of predictive equations and Fick-derived Weir estimates in Italy.","authors":"Antonio Romanelli, Alessandro Calicchio, Salvatore Palmese, Sabato Pascarella, Bruna Pisapia, Renato Gammaldi","doi":"10.4266/acc.001300","DOIUrl":"10.4266/acc.001300","url":null,"abstract":"<p><strong>Background: </strong>Resting energy expenditure (REE) estimation is crucial in critically ill patients. While indirect calorimetry (IC) is the gold standard, its limited availability often necessitates alternative methods. In this exploratory study, we compared the accuracy of the stress factor-corrected Harris-Benedict (cREEHB) and weight-based (REEWB) equations with the Weir equation (REEW) using oxygen consumption (VO₂) and carbon dioxide production (VCO₂) estimated via the Fick principle.</p><p><strong>Methods: </strong>We included patients admitted to the intensive care unit (ICU) between January and August 2024, and computed cREEHB, REEWB (22.5 kcal/kg/day), and REEW. Agreement between methods was assessed through Bland-Altman analysis. Sensitivity and correlation analyses identified bias determinants. Multiple linear regression explored associations of REEW with VO₂, VCO₂, and cardiac output (CO).</p><p><strong>Results: </strong>The sample size consisted of 30 patients. No correlation was found between REEW and cREEHB (r=0.177, P=0.349) or REEWB (r=-0.006, P=0.975). Compared to REEW, cREEHB underestimated REE (mean bias, -47.9 kcal), while REEWB overestimated it (mean bias, +9.7 kcal). CREEHB bias was associated with sex, height, body surface area (BSA), VO2, and respiratory quotient (RQ); REEWB bias was influenced by actual body weight, body mass index, BSA, VO2, and RQ (all P<0.05). Multiple linear regression analysis showed that REEW was influenced by VO2 (P<0.001) and VCO2 (P<0.001) but not by CO (P=0.164).</p><p><strong>Conclusions: </strong>Predictive equations may not be interchangeable in ICU settings, leading to inaccurate metabolic assessments. Studies incorporating IC as a reference are needed to determine the most reliable approach for estimating REE and optimizing nutritional support in critical patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"491-504"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of novel indices combining Shock Index, Reverse Shock Index, age, and oxygen saturation for predicting mortality in COVID-19 patients in Iran at emergency department triage: a cross-sectional study.","authors":"Mehdi Torabi, Atefe Noroozpour, Neda Naeemi Bafghi, Moghaddameh Mirzaee","doi":"10.4266/acc.005040","DOIUrl":"10.4266/acc.005040","url":null,"abstract":"<p><strong>Background: </strong>The objective of the study was to investigate the role of the Shock Index (SI), the Reverse Shock Index (RSI) along with oxygen saturation in predicting mortality in coronavirus disease 2019 (COVID-19).</p><p><strong>Methods: </strong>This cross-sectional study was conducted at an academic hospital over a period of 6 months and involved patients over the age of 18 who had been diagnosed with COVID-19 via positive polymerase chain reaction tests. The data were recorded anonymously using a checklist. The study focused on indices such as the SI and RSI, both alone and in conjunction with age and oxygen saturation, to predict hospital mortality. Statistical analysis was conducted using SPSS software.</p><p><strong>Results: </strong>The study involved 500 COVID-19 patients with a 14.4% mortality rate. Key differences were found between survival and mortality groups in terms of age, vital signs except diastolic blood pressure, length of stay, and a series of laboratory tests. Logistic regression showed gender, oxygen saturation, hemoglobin, direct bilirubin, lactate dehydrogenase, D-dimer, and Age SI/oxygen saturation (SpO2) and RSI×SpO2/Age indices significantly associated with hospital mortality. Receiver operating characteristic analysis indicated Age SI/SpO2 and RSI×SpO2/Age as effective mortality predictors, exhibiting an area under the curve of 0.80 and achieving a sensitivity, specificity, and accuracy of over 70%.</p><p><strong>Conclusions: </strong>The combination of SI, the RSI along with hypoxia, and age has been identified as a potentially more significant role in ruling out hospital mortality in COVID-19 patients than vital signs alone, given the established role of hypoxia as a major risk factor in such cases.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"425-434"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-traumatic stress disorder, anxiety, and depression in North African intensive care unit survivors: a prospective observational study.","authors":"Imen Ben Saida, Marwa Zghidi, Safa Fathallah, Mohamed Boussarsar","doi":"10.4266/acc.000150","DOIUrl":"10.4266/acc.000150","url":null,"abstract":"<p><strong>Background: </strong>Survivors of critical illness often face significant physical and psychological challenges, including post-traumatic stress disorder (PTSD), anxiety, and depression, which can severely impact their quality of life. This study aimed to evaluate the prevalence and associated factors of PTSD, anxiety, and depression among intensive care unit (ICU) survivors 3 months after discharge, and investigate the prevalence and determinants of post-intensive care syndrome-related neuropsychiatric disorders (PICS-ND).</p><p><strong>Methods: </strong>This is a prospective observational analytical study carried out in a medical ICU. Three months after discharge from the ICU, survivors were contacted by telephone to complete the Impact Event Scale-Revised and Hospital Anxiety and Depression Scale questionnaires. Univariate and multivariate analyses were performed to identify variables that were independently and significantly associated with outcomes.</p><p><strong>Results: </strong>A total of 114 survivors was enrolled. At 3 months, PTSD, anxiety, and depression were prevalent in 21.9%, 21.0%, and 9.6% of patients, respectively. Associated factors were younger age, female, physical restraint, and critical illness polyneuropathy and myopathy (CIPNM) for PTSD; unmarried, low Charlson index, and physical restraint for anxiety; and younger age and CIPNM for depression. PICS-ND, a composite measure of neuropsychiatric morbidity, was present in 28.9% of patients, with younger age, female, and physical restraint identified as associated factors.</p><p><strong>Conclusions: </strong>PTSD, anxiety, depression, and PICS-ND were common among ICU survivors at 3 months. Various factors, including younger age, female, unmarried, lower Charlson index, physical restraint, and CIPNM, were associated with these psychological outcomes.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"402-412"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea.","authors":"Leerang Lim, Christine Kang, Minseob Kim, Jinwoo Lee, Hong Yeul Lee, Seung-Young Oh, Ho Geol Ryu, Hannah Lee","doi":"10.4266/acc.000500","DOIUrl":"10.4266/acc.000500","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common but serious complication in critically ill patients. Family visitation has been shown to reduce delirium; however, during the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) restricted regular visitation to prevent the spread of infection. This study aimed to evaluate the association between visitation policies and incidence of delirium in the ICUs.</p><p><strong>Methods: </strong>This was a retrospective before-and-after study conducted in medical and surgical ICUs at a tertiary hospital. Adult patients admitted to an ICU during one of two periods were included: before the COVID-19 pandemic (June 2017 to May 2019) with regular visitation and during the pandemic (June 2020 to May 2022) with prohibited visitation. Delirium was assessed using the Confusion Assessment Method for the ICU. The primary outcome was association between delirium incidence and visitation policy.</p><p><strong>Results: </strong>Totals of 1,566 patients from the pre-COVID-19 period and 1,404 patients from the COVID-19 period were analyzed. The incidence of delirium was higher during the COVID-19 period (48.1% vs. 38.4%, P<0.001). After adjusting for relevant variables, the restricted visitation policy during COVID-19 remained a risk factor for delirium (odds ratio, 1.37; 95% CI, 1.13-1.65; P=0.001).</p><p><strong>Conclusions: </strong>Complete restriction of ICU visitations during the COVID-19 pandemic was associated with a significant increase in delirium incidence. These findings suggest the importance of visitation policies on patient outcomes and suggest the need for alternative strategies, such as video visitation, to mitigate the adverse effects of visitation restrictions during pandemics.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"452-461"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engagement and Perspectives regarding the family conference process when considering discontinuation of life-sustaining treatments among critical care specialist nurses: a nationwide cross-sectional survey in Japan.","authors":"Akane Kato, Yuta Tanaka, Yoshiyuki Kizawa, Hiroaki Yamase, Asami Tado, Junko Tatsuno, Mitsunori Miyashita","doi":"10.4266/acc.003096","DOIUrl":"10.4266/acc.003096","url":null,"abstract":"<p><strong>Background: </strong>Recognizing the importance of multidisciplinary collaboration during treatment family conferences is increasing in critical care settings. We aimed to elucidate how critical care specialist nurses engage in the family conference process in terms of the actual discussions held, the recommended topics, and their perspectives regarding transfer of critical care patients to general wards.</p><p><strong>Methods: </strong>This self-administered nationwide survey was conducted between October and December 2020, targeting a random sample of 740 critical care specialist nurses. An anonymous questionnaire based on established guidelines and pilot tests was used to assess the level of engagement with the family conference process, content of discussions, considerations regarding withholding or withdrawing treatment, and perspectives concerning patient care location and discontinuation of life-sustaining treatments among the surveyed nurses.</p><p><strong>Results: </strong>Of the 396 returned questionnaires (response rate, 51.9%), 384 were analyzed. Less than 35% of the nurses consistently participated in family conferences and ensured that decisions regarding withholding or withdrawing life-sustaining treatments were re-evaluated following the conferences. Discussions focused predominantly on the patients' physical aspects, whereas the nurses believed that patients' values and preferences should be discussed. More than 70% of the nurses supported transferring patients from critical care settings to general wards for end-of-life scenarios.</p><p><strong>Conclusions: </strong>Critical care specialist nurses in Japan exhibit limited engagement in family conferences and often fail to address their patients' values and preferences. Educational programs and enhanced interprofessional collaborations are warranted to improve nurse involvement in family conferences and ensure continuity of care between critical care and general ward settings.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision guidance by an automated, brachial cuff-based cardiac output assessment in patients with shock under treatment: a pilot study in Athens, Greece.","authors":"Dimitrios Xanthis, Panagiotis Kanatas, Dimitrios Mouziouras, Antonios A Argyris, Pavlos Vernikos, Georgia Mastakoura, Elpida Athanasopoulou, Theodore G Papaioannou, Athanase D Protogerou","doi":"10.4266/acc.001728","DOIUrl":"10.4266/acc.001728","url":null,"abstract":"<p><strong>Background: </strong>Cardiac output (CO) estimation in patients in intensive care units (ICUs) by a non-invasive, automated, oscillometric, cuff-based apparatus (Mobil-O-Graph [MG]) is reproducible with acceptable accuracy versus thermodilution. In this pilot study, we tested the hypothesis that clinical decisions based on the MG device are in agreement with those based on invasive measurements using a Swan-Ganz catheter (SGC).</p><p><strong>Methods: </strong>Hemodynamic monitoring using an SGC and an MG was performed on 20 consenting critically ill patients in shock and under treatment, hospitalized in ICU. Retrospectively, three ICU physicians were asked to determine the need for blood transfusion, inotropes, fluids, diuretics, oxygen, and vasoconstrictive agents. Decisions (defined as \"need for action\" or \"no action\") were based: (i) on SGC-acquired data and standard ICU monitoring (SIM); (ii) on MG-acquired data and SIM; (iii) SIM only. The decisions were compared using Cohen's kappa agreement coefficient and Wilcoxon's nonparametric test.</p><p><strong>Results: </strong>The overall number of decisions, as well as the subanalysis of \"need for action\" decisions, based either on information from an SGC or MG, were comparable. The significant positive kappa agreement coefficients indicated moderate to strong agreement. MG-derived decisions agreed with SGC-derived decisions to a significantly higher degree compared with SIM-based decisions.</p><p><strong>Conclusions: </strong>Clinical decisions in the ICU setting based on MG data were in acceptable agreement with SGC-based decisions. Larger studies are required to confirm this finding. MG devices may provide a simple, operator-independent, low-cost, first-line bedside method for simultaneous continuous monitoring of blood pressure and CO levels in critically ill patients outside the ICU.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"273-281"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective external validation of a deep-learning-based early-warning system for major adverse events in general wards in South Korea.","authors":"Taeyong Sim, Eun Young Cho, Ji-Hyun Kim, Kyung Hyun Lee, Kwang Joon Kim, Sangchul Hahn, Eun Yeong Ha, Eunkyeong Yun, In-Cheol Kim, Sun Hyo Park, Chi-Heum Cho, Gyeong Im Yu, Byung Eun Ahn, Yeeun Jeong, Joo-Yun Won, Hochan Cho, Ki-Byung Lee","doi":"10.4266/acc.000525","DOIUrl":"10.4266/acc.000525","url":null,"abstract":"<p><strong>Background: </strong>Acute deterioration of patients in general wards often leads to major adverse events (MAEs), including unplanned intensive care unit transfers, cardiac arrest, or death. Traditional early warning scores (EWSs) have shown limited predictive accuracy, with frequent false positives. We conducted a prospective observational external validation study of an artificial intelligence (AI)-based EWS, the VitalCare - Major Adverse Event Score (VC-MAES), at a tertiary medical center in the Republic of Korea.</p><p><strong>Methods: </strong>Adult patients from general wards, including internal medicine (IM) and obstetrics and gynecology (OBGYN)-the latter were rarely investigated in prior AI-based EWS studies-were included. The VC-MAES predictions were compared with National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) predictions using the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), and logistic regression for baseline EWS values. False-positives per true positive (FPpTP) were assessed based on the power threshold.</p><p><strong>Results: </strong>Of 6,039 encounters, 217 (3.6%) had MAEs (IM: 9.5%, OBGYN: 0.26%). Six hours prior to MAEs, the VC-MAES achieved an AUROC of 0.918 and an AUPRC of 0.352, including the OBGYN subgroup (AUROC, 0.964; AUPRC, 0.388), outperforming the NEWS (0.797 and 0.124) and MEWS (0.722 and 0.079). The FPpTP was reduced by up to 71%. Baseline VC-MAES was strongly associated with MAEs (P<0.001).</p><p><strong>Conclusions: </strong>The VC-MAES significantly outperformed traditional EWSs in predicting adverse events in general ward patients. The robust performance and lower FPpTP suggest that broader adoption of the VC-MAES may improve clinical efficiency and resource allocation in general wards.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 2","pages":"197-208"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}