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Nelson K, Brooks M, Mead-Harvey C, Quill J, Kiley B, Peworski C, Ritchie A, Sen A. Nurse-led medical emergency response reduces code blue team activations in non-hospitalized patients. Resusc Plus 2024; 18:100642. [PMID: 38689849 PMCID: PMC11059126 DOI: 10.1016/j.resplu.2024.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 05/02/2024] Open
Abstract
Objective We describe the creation of a two-tier emergency response system with a nurse-led first responder program titled "MET-RN" (Medical Emergency Team-Registered Nurse) created for ambulatory settings supported by a critical care code blue team for escalation of care. This observational study evaluated the clinical characteristics and effects of a MET-RN program on the code blue response. Methods A retrospective review of the MET-RN response data was assessed from January 2016 to June 2021. Data collected included time of call, call location, patient comorbidities, triage category (minor, urgent, or emergent), activation trigger, interventions performed, duration of the event, and patient disposition. In instances where the patient was admitted to the hospital, the discharge diagnosis and emergency department (ED) triage score were collected. Differences were tested using analysis of variance (ANOVA) F-tests, with Tukey post-hoc testing where applicable. Results MET-RN responded to 6,564 encounters from January 2016 to June 2021. The most frequent trigger call was dizziness/lightheadedness, with a prevalence of 12.0%. 33.9% of the patients seen by MET-RN were transported to the ED for further evaluation. Establishing a MET-RN system led to an estimated median of 58.3% reduction in utilization of the code blue team per quarter. Conclusion The creation of MET-RN first responder system enabled the ambulatory areas to receive minor, urgent, and emergent patient care support, leading to a decrease in utilization of the code blue team for the hospital. A two-tiered response system resulted in an improved allocation of hospital resources and kept critical care teams in high-acuity areas while maintaining patient safety.
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Affiliation(s)
- Kiley Nelson
- Department of Critical Care Medicine, United States
| | | | | | - Janae Quill
- Department of Critical Care Medicine, United States
| | | | | | | | - Ayan Sen
- Department of Critical Care Medicine, United States
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Eisenkraft A, Goldstein N, Merin R, Fons M, Ishay AB, Nachman D, Gepner Y. Developing a real-time detection tool and an early warning score using a continuous wearable multi-parameter monitor. Front Physiol 2023; 14:1138647. [PMID: 37064911 PMCID: PMC10090377 DOI: 10.3389/fphys.2023.1138647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Currently-used tools for early recognition of clinical deterioration have high sensitivity, but with low specificity and are based on infrequent measurements. We aimed to develop a pre-symptomatic and real-time detection and warning tool for potential patients’ deterioration based on multi-parameter real-time warning score (MPRT-WS).Methods: A total of more than 2 million measurements were collected, pooled, and analyzed from 521 participants, of which 361 were patients in general wards defined at high-risk for deterioration and 160 were healthy participants allocation as controls. The risk score stratification was based on cutoffs of multiple physiological parameters predefined by a panel of specialists, and included heart rate, blood oxygen saturation (SpO2), respiratory rate, cuffless systolic and diastolic blood pressure (SBP and DBP), body temperature, stroke volume (SV), cardiac output, and systemic vascular resistance (SVR), recorded every 5 min for a period of up to 72 h. The data was used to define the various risk levels of a real-time detection and warning tool, comparing it with the clinically-used National Early Warning Score (NEWS).Results: When comparing risk levels among patients using both tools, 92.6%, 6.1%, and 1.3% of the readings were defined as “Low”, “Medium”, and “High” risk with NEWS, and 92.9%, 6.4%, and 0.7%, respectively, with MPRT-WS (p = 0.863 between tools). Among the 39 patients that deteriorated, 30 patients received ‘High’ or ‘Urgent’ using the MPRT-WS (42.7 ± 49.1 h before they deteriorated), and only 6 received ‘High’ score using the NEWS. The main abnormal vitals for the MPRT-WS were SpO2, SBP, and SV for the “Urgent” risk level, DBP, SVR, and SBP for the “High” risk level, and DBP, SpO2, and SVR for the “Medium” risk level.Conclusion: As the new detection and warning tool is based on highly-frequent monitoring capabilities, it provides medical teams with timely alerts of pre-symptomatic and real-time deterioration.
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Affiliation(s)
- Arik Eisenkraft
- Biobeat Technologies Ltd., Petach Tikva, Israel
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Israel Defense Force Medical Corps, Jerusalem, Israel
| | | | - Roei Merin
- Biobeat Technologies Ltd., Petach Tikva, Israel
| | - Meir Fons
- Biobeat Technologies Ltd., Petach Tikva, Israel
| | | | - Dean Nachman
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Israel Defense Force Medical Corps, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Yftach Gepner,
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Itelman E, Shlomai G, Leibowitz A, Weinstein S, Yakir M, Tamir I, Sagiv M, Muhsen A, Perelman M, Kant D, Zilber E, Segal G. Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study. JMIR Form Res 2022; 6:e36066. [PMID: 35679119 PMCID: PMC9227660 DOI: 10.2196/36066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a “wish list” score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359
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Affiliation(s)
- Edward Itelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gadi Shlomai
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Avshalom Leibowitz
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Shiri Weinstein
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maya Yakir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Idan Tamir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Michal Sagiv
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Aia Muhsen
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maxim Perelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Daniella Kant
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Eyal Zilber
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gad Segal
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
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Lalueza A, Lora-Tamayo J, de la Calle C, Sayas-Catalán J, Arrieta E, Maestro G, Mancheño-Losa M, Marchán-López Á, Díaz-Simón R, García-García R, Catalán M, García-Reyne A, de Miguel-Campo B, Lumbreras C. The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19. Rev Clin Esp 2022; 222:293-298. [PMID: 35512908 PMCID: PMC7888251 DOI: 10.1016/j.rceng.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤200 mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥4 was found to be the best cutoff point for predicting respiratory failure.
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Affiliation(s)
- A Lalueza
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - J Lora-Tamayo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain
| | - C de la Calle
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Sayas-Catalán
- Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain; Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Arrieta
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Maestro
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Mancheño-Losa
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain
| | - Á Marchán-López
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Díaz-Simón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - R García-García
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Catalán
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A García-Reyne
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B de Miguel-Campo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Lumbreras
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
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Lv C, Chen Y, Shi W, Pan T, Deng J, Xu J. Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population. Clin Interv Aging 2021; 16:1917-1929. [PMID: 34737556 PMCID: PMC8560064 DOI: 10.2147/cia.s335315] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/21/2021] [Indexed: 01/22/2023] Open
Abstract
Background The incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. Different scoring systems, including The quick Sequential Organ Function Assessment (qSOFA), Combination of Confusion, Urea, Respiratory Rate, Blood Pressure, and Age ≥65 (CURB-65), Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS), were used widely for predicting mortality and ICU admission of patients with community-acquired pneumonia (CAP). This study aimed to identify the most suitable score system for better hospitalization. Methods We retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University from 1 January 2018 to 1 January 2020. We recorded information of the patients including age, gender, underlying disease, consciousness state, vital signs, physiological and laboratory variables and further calculated the qSOFA, CURB-65, MEWS, and NEWS scores. Receiver operating characteristic (ROC) curves were used to predict the mortality risk and ICU admission. Kaplan–Meier survival curves were used in survival rate. Results In total, 1044 patients were selected for analysis and divided into two groups, namely survivor groups (902 cases) and non-survivor groups (142 cases). Depending on ICU admission enrolled patients were classified into ICU admission (n = 102) and non-ICU admission (n = 942) groups. Mortality expressed as AUC values were 0.844 (p < 0.001), 0.868 (p < 0.001), 0.927 (p < 0.001) and 0.892 (p < 0.001) for qSOFA, CURB 65, MEWS and NEWS, respectively. There were clear differences in MEWS vs CURB-65 (p < 0.0001), MEWS vs NEWS (p < 0.001), MEWS vs qSOFA (p < 0.0001). For ICU-admission, the AUC values of qSOFA, CURB-65, MEWS and NEWS scores were 0.866 (p < 0.001), 0.854 (p < 0.001), 0.922 (p < 0.001), 0.976 (p < 0.001), respectively. There were significant differences in NEWS vs CURB-65 (p < 0.0001), NEWS vs MEWS (p < 0.001), NEWS vs qSOFA (p < 0.0001). Conclusion We explored the outcome prediction values of CURB65, qSOFA, MEWS and NEWS for patients aged 65-years and older with community-acquired pneumonia. We found that MEWS showed superiority over the other severity scores in predicting hospital mortality, and NEWS showed superiority over the other scores in predicting ICU admission.
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Affiliation(s)
- Chunxin Lv
- Oncology Department, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Yue Chen
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, London, EC1M 6BE, UK
| | - Wen Shi
- Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Teng Pan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Jinhai Deng
- Key Laboratory of Medical Immunology, Department of Immunology, Peking University Center for Human Disease Genomics, Ministry of Health, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Jiayi Xu
- Geriatric Department, Fudan University, Minhang Hospital, Shanghai, 201100, People's Republic of China
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Kim SH, Choi HS, Jin ES, Choi H, Lee H, Lee SH, Lee CY, Lee MG, Kim Y. Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study. Sci Rep 2021; 11:18021. [PMID: 34504146 PMCID: PMC8429773 DOI: 10.1038/s41598-021-97121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
There are insufficient data in managing patients at high risk of deterioration. We aimed to investigate that national early warning score (NEWS) could predict severe outcomes in patients identified by a rapid response system (RRS), focusing on the patient’s age. We conducted a retrospective cohort study from June 2019 to December 2020. Outcomes were unplanned intensive care unit (ICU) admission, ICU mortality, and in-hospital mortality. We analyzed the predictive ability of NEWS using receiver operating characteristics (ROC) curve and the effect of NEWS parameters using multivariable logistic regression. A total of 2,814 RRS activations were obtained. The predictive ability of NEWS for unplanned ICU admission and in-hospital mortality was fair but was poor for ICU mortality. The predictive ability of NEWS showed no differences between patients aged 80 years or older and under 80 years. However, body temperature affected in-hospital mortality for patients aged 80 years or older, and the inverse effect on unplanned ICU admission was observed. The NEWS showed fair predictive ability for unplanned ICU admission and in-hospital mortality among patients identified by the RRS. The different presentations of patients 80 years or older should be considered in implementing the RRS.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Suk Choi
- Department of Rapid Response Team, Advanced Practice Nurse, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Eun Suk Jin
- Department of Rapid Response Team, Advanced Practice Nurse, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon, Gangwon-do, 24253, Korea
| | - Myung Goo Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon, Gangwon-do, 24253, Korea
| | - Youlim Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon, Gangwon-do, 24253, Korea.
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Higashino M, Hiraoka E, Kudo Y, Hoshina Y, Kitamura K, Sakai M, Ito S, Fujimoto Y, Hiasa Y, Hayashi K, Fujitani S, Suzuki T. Role of a rapid response system and code status discussion as determinants of prognosis for critical inpatients: An observational study in a Japanese urban hospital. Medicine (Baltimore) 2021; 100:e26856. [PMID: 34397894 PMCID: PMC8360430 DOI: 10.1097/md.0000000000026856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ± 13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.
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Affiliation(s)
- Makoto Higashino
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Eiji Hiraoka
- Department of General Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoshiko Kudo
- Intensive Care Unit, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yuiko Hoshina
- Strategic Planning and Analysis Division, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Koichi Kitamura
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Masahiro Sakai
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Shinsuke Ito
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoshihisa Fujimoto
- Department of Emergency and Critical Care Medicine, Division of Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koichi Hayashi
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toshihiko Suzuki
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
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Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med 2021; 11:jpm11030170. [PMID: 33801375 PMCID: PMC8001393 DOI: 10.3390/jpm11030170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022] Open
Abstract
Early warning scores (EWSs) help prevent and recognize and thereby act as the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different EWSs (National Early Warning Score 2 (NEWS2), quick sequential organ failure assessment score (qSOFA), Modified Rapid Emergency Medicine Score (MREMS) and Rapid Acute Physiology Score (RAPS)) to predict mortality within the first 48 h in patients suspected to have Coronavirus disease 2019 (COVID-19). We conducted a retrospective observational study in patients over 18 years of age who were treated by the advanced life support units and transferred to the emergency departments between March and July of 2020. Each patient was followed for two days registering their final diagnosis and mortality data. A total of 663 patients were included in our study. Early mortality within the first 48 h affected 53 patients (8.3%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2 (NEWS2), with an area under the curve of 0.825 (95% CI: 0.75–0.89). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients presented an area under the curve (AUC) of 0.804 (95% CI: 0.71–0.89), and the negative ones with an AUC of 0.863 (95% CI: 0.76–0.95). Among the EWSs, NEWS2 presented the best predictive power, even when it was separately applied to patients who tested positive and negative for SARS-CoV-2.
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Aoyama T, Tsuneyoshi I, Otake T, Ouchi K, Kawase Y, Arai M, Shibata N, Fujiwara S, Fujitani S. Rapid response system in Japanese outpatient departments based on online registry: Multicentre observational study. Resusc Plus 2021; 5:100065. [PMID: 34223336 PMCID: PMC8244486 DOI: 10.1016/j.resplu.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Aim The rapid response system (RRS) has become well known as a patient safety system to reduce adverse in-patient events, and it is also required to respond to patients in the outpatient department. However, only few studies have reported on the RRS in the outpatient department. We analysed the current status of the RRS in the outpatient department based on a multicentre online registry in Japan. Methods This is a prospective multicentre observational study. Among the cases registered in the RRS online registry from January 2014 to March 2018, cases from the outpatient department, consisting of the general outpatient department, radiation department, dialysis department, endoscope department, rehabilitation department, and the surrounding areas were eligible for this study. Results A total of 6784 cases were registered, and 1022 cases were included. The main reason for activation was altered mental status (39.1%). Incomplete vital sign recording at activation was 67.0%, whereas body temperature (57.0%) and respiratory rate (36.4%) deficits were frequent. The most common intervention during RRS activation was fluid bolus (38.2%) and oxygen supplementation (30.9%). The general outpatient department accounted for nearly half of the activation locations. The 30-day mortality rate for the location was significantly higher in the dialysis department (P < 0.001). Conclusions We have reported the first study of RRSs in outpatient departments at multicentre facilities in Japan. The difference in the mortality rate for the location was clarified. Future tasks will involve clarifying the RRS outcome indicators in the outpatient department and examining the effectiveness thereof.
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Affiliation(s)
- Takeshi Aoyama
- Department of Emergency and Critical Care Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu-cyou, Miyazaki City, Miyazaki 880-0017, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cyou, Miyazaki City, Miyazaki 889-1692, Japan
| | - Isao Tsuneyoshi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cyou, Miyazaki City, Miyazaki 889-1692, Japan
| | - Takanao Otake
- Department of Anesthesiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama 710-8602, Japan
| | - Kazuo Ouchi
- Department of Medical Safety Management, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Yuta Kawase
- Department of Internal Medicine, Kyoritsu General Hospital, 4-33 Goban-cyou, Atsuta-ku, Nagoya City, Aichi 456-8611, Japan
| | - Masayasu Arai
- Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa 252-0375, Japan
| | - Naoaki Shibata
- Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Shinsuke Fujiwara
- Department of Emergency Medicine, National Hospital Organization Ureshino Medical Center, 4279-3 Shimojuku-hei, Oaza, Ureshino-machi, Ureshino City, Saga 843-0393, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan
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10
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Lalueza A, Lora-Tamayo J, de la Calle C, Sayas-Catalán J, Arrieta E, Maestro G, Mancheño-Losa M, Marchán-López Á, Díaz-Simón R, García-García R, Catalán M, García-Reyne A, de Miguel-Campo B, Lumbreras C. [The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19]. Rev Clin Esp 2020; 222:293-298. [PMID: 33191944 PMCID: PMC7648653 DOI: 10.1016/j.rce.2020.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas SOFA (Sequential Organ Failure Assessment), qSOFA (Quick SOFA), NEWS (National Early Warning Score ) y Quick NEWS para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos (UCI). Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento. El fallo respiratorio se definió como un cociente PaO2/FiO2 ≤ 200 mmHg o la necesidad de ventilación mecánica. Setenta y siete pacientes (32,5%) desarrollaron fallo ventilatorio; 29 (12%) precisaron ingreso en UCI, y 49 fallecieron (20,7%). La discriminación del fallo ventilatorio fue algo mayor con la puntuación NEWS, seguida de la SOFA. En cuanto a la mortalidad, la puntuación SOFA fue más exacta que las otras escalas. En conclusión, las escalas de sepsis son útiles para predecir el fallo respiratorio y la muerte en COVID-19. Una puntuación ≥ 4 en la escala NEWS sería el mejor punto de corte para predecir fallo respiratorio.
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Affiliation(s)
- A Lalueza
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - J Lora-Tamayo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - C de la Calle
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Sayas-Catalán
- Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España.,Servicio de Medicina Respiratoria, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Arrieta
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - G Maestro
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Mancheño-Losa
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - Á Marchán-López
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Díaz-Simón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - R García-García
- Servicio de Medicina Respiratoria, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Catalán
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, España
| | - A García-Reyne
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - B de Miguel-Campo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Lumbreras
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España.,Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España
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11
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Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051504. [PMID: 32110959 PMCID: PMC7084570 DOI: 10.3390/ijerph17051504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/20/2022]
Abstract
Traumatic brain injuries are complex situations in which the emergency medical services must quickly determine the risk of deterioration using minimal diagnostic methods. The aim of this study is to analyze whether the use of early warning scores can help with decision-making in these dynamic situations by determining the patients who need the intensive care unit. A prospective, multicentric cohort study without intervention was carried out on traumatic brain injury patients aged over 18 given advanced life support and taken to the hospital. Our study included a total of 209 cases. The total number of intensive-care unit admissions was 50 cases (23.9%). Of the scores analyzed, the National Early Warning Score2 was the best result presented with an area under the curve of 0.888 (0.81–0.94; p < 0.001) and an odds ratio of 25.4 (95% confidence interval (CI):11.2–57.5). The use of early warning scores (and specifically National Early Warning Score2) can help the emergency medical services to differentiate traumatic brain injury patients with a high risk of deterioration. The emergency medical services should use the early warning scores routinely in all cases for the early detection of high-risk situations.
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