Causes, Diagnostic Testing, and Treatments Related to Clinical Deterioration Events Among High-Risk Ward Patients.

Autor:	Churpek MM; Department of Medicine, University of Wisconsin-Madison, Madison, WI.; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI., Ingebritsen R; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Carey KA; Department of Medicine, University of Chicago, Chicago, IL., Rao SA; Department of Surgery, Northwestern Memorial Hospital, Chicago, IL., Murnin E; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Qyli T; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Oguss MK; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Picart J; Department of Surgery, University of Michigan, Ann Arbor, MI., Penumalee L; Department of Medicine, University of Chicago, Chicago, IL., Follman BD; Department of Medicine, Loyola University Medical Center, Chicago, IL., Nezirova LK; Department of Medicine, Loyola University Medical Center, Chicago, IL., Tully ST; Department of Medicine, Loyola University Medical Center, Chicago, IL., Benjamin C; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Nye C; Department of Medicine, University of Wisconsin-Madison, Madison, WI., Gilbert ER; Department of Medicine, Loyola University Medical Center, Chicago, IL., Shah NS; Department of Medicine, Endeavor Health, Evanston, IL., Winslow CJ; Department of Medicine, Endeavor Health, Evanston, IL., Afshar M; Department of Medicine, University of Wisconsin-Madison, Madison, WI.; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI., Edelson DP; Department of Medicine, University of Chicago, Chicago, IL.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2024 Oct 01; Vol. 6 (10), pp. e1161. Date of Electronic Publication: 2024 Oct 01 (Print Publication: 2024).
DOI:	10.1097/CCE.0000000000001161
Abstrakt:	Importance: Timely intervention for clinically deteriorating ward patients requires that care teams accurately diagnose and treat their underlying medical conditions. However, the most common diagnoses leading to deterioration and the relevant therapies provided are poorly characterized. Objectives: We aimed to determine the diagnoses responsible for clinical deterioration, the relevant diagnostic tests ordered, and the treatments administered among high-risk ward patients using manual chart review. Design, Setting, and Participants: This was a multicenter retrospective observational study in inpatient medical-surgical wards at four health systems from 2006 to 2020. Randomly selected patients (1000 from each health system) with clinical deterioration, defined by reaching the 95th percentile of a validated early warning score, electronic Cardiac Arrest Risk Triage, were included. Main Outcomes and Measures: Clinical deterioration was confirmed by a trained reviewer or marked as a false alarm if no deterioration occurred for each patient. For true deterioration events, the condition causing deterioration, relevant diagnostic tests ordered, and treatments provided were collected. Results: Of the 4000 included patients, 2484 (62%) had clinical deterioration confirmed by chart review. Sepsis was the most common cause of deterioration (41%; n = 1021), followed by arrhythmia (19%; n = 473), while liver failure had the highest in-hospital mortality (41%). The most common diagnostic tests ordered were complete blood counts (47% of events), followed by chest radiographs (42%) and cultures (40%), while the most common medication orders were antimicrobials (46%), followed by fluid boluses (34%) and antiarrhythmics (19%). Conclusions and Relevance: We found that sepsis was the most common cause of deterioration, while liver failure had the highest mortality. Complete blood counts and chest radiographs were the most common diagnostic tests ordered, and antimicrobials and fluid boluses were the most common medication interventions. These results provide important insights for clinical decision-making at the bedside, training of rapid response teams, and the development of institutional treatment pathways for clinical deterioration. Competing Interests: Drs. Churpek and Edelson are named inventors on a patent (No. 11,410,777) for electronic Cardiac Arrest Risk Triage (eCART) and receive royalties from the University of Chicago for this intellectual property. Dr. Edelson is employed by and has an equity stake in AgileMD, which markets and distributes eCART. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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