院内心脏骤停前的生理恶化：国家预警评分-2（National Early Warning Score-2）漏掉了什么？

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2024-09-30 DOI:10.1016/j.resplu.2024.100788

Sherif Gonem , Daniella Draicchio , Ayad Mohamed , Sally Wood , Kelly Shiel , Steve Briggs , Tricia M McKeever , Dominick Shaw

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引用次数: 0

摘要

方法我们对位于城市中心（英国诺丁汉）的两家大型急症医院在2019年7月1日至2021年12月31日期间发生院内心脏骤停（IHCA）的所有成年患者（年龄≥18岁）进行了一项回顾性观察研究。研究人员对 IHCA 事件发生前的临床观察和病例记录进行了检查，以确定是否有生理恶化的证据表明需要对患者进行紧急评估、NEWS-2 是否被触发，以及是否实际进行了紧急评估。在 89/106 例（84.0%）NEWS-2 被触发的病例中进行了紧急评估，在 13/20 例（65.0%）NEWS-2 未被触发的病例中进行了紧急评估，比例差异具有统计学意义（p = 0.048）。结论相当一部分 IHCA 事件发生前会出现临床上重要的生命体征异常，但 NEWS-2 没有检测到。这可能是某些抢救失败事件的诱因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?

Aim

To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA).

Methods

We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place.

Results

Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement.

Conclusions

A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.

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来源期刊

Resuscitation plus Critical Care and Intensive Care Medicine, Emergency Medicine

CiteScore

3.00

自引率

0.00%

发文量

审稿时长

52 days