使用院前预警评分预测短期死亡率:一项系统综述

IF 1.7 4区 医学 Q2 EMERGENCY MEDICINE
David Naylor MPhil, Bridget Dicker PhD, Graham Howie PhD, Verity Todd PhD
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引用次数: 0

摘要

早期预警评分(EWS)已被开发用于识别有恶化风险的患者。尽管EWS在院前环境中的应用越来越成熟,但其使用仍存在争议。本系统综述的目的是总结EWS对院前成人短期死亡率预测准确性的最新证据。使用Medline、CINAHL和Scopus数据库进行系统检索。包括评估院前修正预警评分、国家预警评分或国家预警评分2在预测死亡率方面的诊断准确性的研究。次要结局是重症监护病房(ICU)住院和住院。该综述纳入了2012年至2023年间发表的16项研究,患者总数为311 932例。文献显示院前EWS在预测短期死亡率方面表现出中等至良好的诊断性能,其受试者工作特征曲线下面积范围为0.68(95%可信区间[CI]: 0.64-0.73)至0.90 (95% CI: 0.82-0.97)。总体而言,在短时间内(最多48小时)预测死亡率的诊断性能更高。需要使用相对较高的分界点来识别高危患者,这可能会限制其在院前环境中未选择的患者群体中的使用。分类不足和过度分类的可能性进一步限制了它们的使用。EWS不应该取代结构化的临床评估和判断,但可以作为辅助和客观的工具来帮助识别有风险的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Review article: Use of prehospital early warning scores to predict short-term mortality: A systematic review

Review article: Use of prehospital early warning scores to predict short-term mortality: A systematic review

Early Warning Scores (EWS) have been developed to identify patients at risk of deterioration. Although the application of EWS has become increasingly established in the prehospital setting, their use remains contentious. The aim of this systematic review is to summarise the most recent evidence on the predictive accuracy of the EWS for short-term mortality in adults in the prehospital setting. A systematic search was conducted using the Medline, CINAHL, and Scopus databases. Studies that evaluated the diagnostic accuracy of the prehospital Modified Early Warning Score, National Early Warning Score or National Early Warning Score 2 in predicting mortality were included. Secondary outcomes were intensive care unit (ICU) admission and hospital admission. The review included 16 studies published between 2012 and 2023, with the number of patients totalling 311 932. The literature indicated that prehospital EWS demonstrated a moderate to good diagnostic performance in predicting short-term mortality with an area under receiver operating characteristic curve ranging from 0.68 (95% confidence interval [CI]: 0.64–0.73) to 0.90 (95% CI: 0.82–0.97). Overall, diagnostic performance was higher for predicting mortality in short time frames (up to 48 h). The need to use relatively high cut-off points to identify at-risk patients may limit its use for the unselected patient populations found in the prehospital setting. The potential for under-triage and over-triage limits their use further. EWS should not replace structured clinical evaluation and judgement but may be useful as complementary and objective tools to aid the identification of patients at risk.

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来源期刊
Emergency Medicine Australasia
Emergency Medicine Australasia 医学-急救医学
CiteScore
3.70
自引率
13.00%
发文量
217
审稿时长
6-12 weeks
期刊介绍: Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.
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