Widely used track and trigger scores: are they ready for automation in practice?

Autor: Romero-Brufau S; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States., Huddleston JM; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: huddleston.jeanne@mayo.edu., Naessens JM; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Johnson MG; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Hickman J; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Morlan BW; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Jensen JB; Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Caples SM; Division of Pulmonary Medicine and Critical Care, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Elmer JL; Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Schmidt JA; Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Morgenthaler TI; Division of Pulmonary Medicine and Critical Care, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States., Santrach PJ; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2014 Apr; Vol. 85 (4), pp. 549-52. Date of Electronic Publication: 2014 Jan 07.
DOI: 10.1016/j.resuscitation.2013.12.017
Abstrakt: Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated.
Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients.
Results: PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year.
Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.
(Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)
Databáze: MEDLINE
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