Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
1.
Invest. educ. enferm ; 39(3): 49-62, 15 octubre del 2021. Tab, Ilus
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1348004

ABSTRACT

Objective. To evaluate the ability of the NEWS2-L (National Early Warning Score 2 Lactate) scale to predict the risk of early clinical deterioration (mortality within 48 hours) in patients with dyspnoea treated by the Medical Emergency Services compared with NEWS2 and lactate in isolation. Methods. Prospective, multi-centre study of a cohort of 638 patients with dyspnoea treated in the ambulance and priority-transferred to a hospital emergency service in the cities of Valladolid, Salamanca, Segovia or Burgos (Spain). We collected clinical, analytical and demographic data. The main outcome measure was all-cause mortality within 48 hours. The recommendations of the Royal College of Physicians were followed to calculate NEWS2. When NEWS2 and LA prehospital values were obtained, the two values were added together to obtain the NEWS2-L. Results. Mortality within 48 hours was fifty-six patients (8.8%). The NEWS2-L scale obtained an area under the curve (AUC) of the receiver operating characteristics (ROC) for mortality within 48 hours of 0.854 (CI 95% 0.790­0.917), at seven days of 0.788 (CI 95% 0.729­0.848) and at 30 days of 0.744 (CI 95% 0.692­0.796); in all cases p<0.001, with a significant decrease between the value at 48 hours and at 30 days. Conclusion. The NEWS2-L scale was found to be significantly superior to the NEWS2 scale and similar to lactate in predicting early clinical deterioration in patients with dyspnoea. This scale can help a nurse detect these patients early, as part of their regular practice, and thus guide therapeutic efforts.


Objetivo. Evaluar la capacidad de la escala NEWS2-L (National Early Warning Score 2-lactate) para predecir el riesgo de deterioro clínico precoz (mortalidad hasta las 48h) en pacientes con disnea atendidos por Servicios de Emergencias Médicas, comparado con la escala NEWS2 y el ácido láctico en solitario. Métodos. Estudio prospectivo multicéntrico de cohorte de 638 pacientes con disnea atendidos en ambulancia y trasladados con alta prioridad a un servicio de urgencias hospitalarias en las ciudades de Valladolid, Salamanca, Segovia y Burgos (España). Se tomó información de variables clínicas, analíticas y demográficas, de las cuales la de resultado principal fue la mortalidad por cualquier causa hasta las 48 horas. Para el cálculo del NEWS2 se siguieron las recomendaciones del Royal College of Physicians. Una vez obtenidos los valores del NEWS2 y del AL prehospitalario se sumaron ambos valores y se obtuvo la NEWS2-L. Resultados. La mortalidad, antes de las 48, horas fue de 56 pacientes (8.8%). La escala NEWS2-L obtuvo un Área Bajo la Curva ­ Característica Operativa del Receptor (ABC-COR) para la mortalidad antes de las 48 horas de 0.854 (IC95% 0.790-0.917), a siete días de 0.788 (IC95% 0.729-0.848) y a 30 días de 0.744 (IC95% 0.692-0.796); en todos los casos p<0.001), lo que experimentó un descenso importante entre su valor a las 48 h y a los 30 días. Conclusión. La escala NEWS2-L mostró ser significativamente superior a la escala NEWS2 y similar al ácido láctico en la predicción del deterioro clínico precoz en pacientes con disnea. Esta escala es una ayuda para que la enfermera en su práctica habitual detecte a estos pacientes en forma temprana y así poder orientar los esfuerzos terapéuticos.


Objetivo. Avaliar a capacidade da escala NEWS2-L (National Early Warning Score 2-lactato) de predizer o risco de deterioração clínica precoce (mortalidade de até 48h) em pacientes com dispneia tratados em Serviços de Emergência Médica, em comparação com a escala NEWS2 e a ácido láctico em solitário. Métodos. Estudo prospectivo de coorte multicêntrico de 638 pacientes com dispneia atendidos por ambulância e transferidos com alta prioridade para um serviço de emergência hospitalar nas cidades de Valladolid, Salamanca, Segovia e Burgos (Espanha). As informações foram obtidas a partir de variáveis clínicas, analíticas e demográficas, sendo a principal variável de desfecho a mortalidade por todas as causas em até 48 horas. Para o cálculo do NEWS2, foram seguidas as recomendações do Royal College of Physicians. Uma vez obtidos os valores do NEWS2 e do AL pré-hospitalar, ambos os valores foram somados e o NEWS2-L foi obtido. Resultados. A mortalidade antes de 48 horas foi de 56 pacientes (8,8%). A escala NEWS2-L obteve uma área sob a curva - característica operacional do receptor (ABC-COR) para mortalidade antes de 48 horas de 0.854 (IC 95% 0.790-0.917), em sete dias de 0.788 (IC 95% 0.729-0.848) e aos 30 dias de 0.744 (95% CI 0.692-0.796); em todos os casos p <0,001), experimentando uma diminuição significativa entre o seu valor às 48 he aos 30 dias. Conclusão. A escala NEWS2-L mostrou ser significativamente superior à escala NEWS2 e semelhante ao ácido láctico na predição da deterioração clínica precoce em pacientes com dispneia. Essa escala é um auxílio para o enfermeiro em sua prática habitual detectar precocemente esses pacientes e, assim, ser capaz de orientar os esforços terapêuticos.


Subject(s)
Humans , Male , Female , Biomarkers , Hospital Mortality , Dyspnea , Clinical Decision-Making , Prehospital Care , Early Warning Score
2.
Medicina (B.Aires) ; 81(4): 508-526, ago. 2021. graf
Article in English | LILACS | ID: biblio-1346502

ABSTRACT

Abstract Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. Early and accurate identifica tion of high-risk patients in the course of the current COVID-19 pandemic is vital for planning and making proper use of available resources. The purpose of this study was to identify the key variables that account for worse outcomes to create a predictive model that could be used effectively for triage. Through literature review, 44 variables that could be linked to an unfavorable course of COVID-19 disease were obtained, including clinical, laboratory, and X-ray variables. These were used for a 2-round modified Delphi processing with 14 experts to select a final list of variables with the greatest predictive power for the construction of a scoring system, leading to the creation of a new scoring system: the COVID-19 Severity Index. The analysis of the area under the curve for the COVID-19 Severity Index was 0.94 to predict the need for ICU admission in the following 24 hours against 0.80 for NEWS-2. Additionally, the digital medical record of the Hospital Italiano de Buenos Aires was electronically set for an automatic calculation and constant update of the COVID-19 Severity Index. Specifically designed for the current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization, and administration of resources by easily identifying hospitalized patients with a greater need of intensive care.


Resumen La pandemia por COVID-19 planteó un desafío para el sistema salud, debido a la gran demanda de pacientes hospitalizados. La identificación temprana de pacientes hospitalizados con riesgo de evo lución desfavorable es vital para asistir en forma oportuna y planificar la demanda de recursos. El propósito de este estudio fue identificar las variables predictivas de mala evolución en pacientes hospitalizados por COVID-19 y crear un modelo predictivo que pueda usarse como herramienta de triage. A través de una revisión narrativa, se obtuvieron 44 variables vinculadas a una evolución desfavorable de la enfermedad COVID-19, incluyendo variables clínicas, de laboratorio y radiográficas. Luego se utilizó un procesamiento por método Delphi modificado de 2 rondas para seleccionar una lista final de variables incluidas en el score llamado COVID-19 Severity Index. Luego se calculó el Área Bajo la Curva (AUC) del score para predecir el pase a terapia intensiva en las próximas 24 horas. El score presentó un AUC de 0,94 frente a 0,80 para NEWS-2. Finalmente se agregó el COVID-19 Severity Index a la historia clínica electrónica de un hospital universitario de alta complejidad. Se programó para que el mismo se actualice de manera automática, facilitando la planificación estratégica, organización y administración de recursos a través de la identificación temprana de pacientes hospitalizados con mayor riesgo de transferencia a la Unidad de Cuidados Intensivos.


Subject(s)
Humans , Early Warning Score , COVID-19 , Triage , Pandemics , SARS-CoV-2
3.
Rev. colomb. obstet. ginecol ; 72(2): 171-190, Apr.-June 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1289315

ABSTRACT

Resumen Introducción y objetivo: Una importante proporción de pacientes hospitalizados presenta deterioro clínico severo que puede terminar en eventos adversos, paro cardíaco no esperado, o muerte; para reducir su frecuencia y prevenir sus consecuencias se han creado los equipos de respuesta rápida (ERR). El objetivo de esta revisión de alcance es describir la conformación, funcionamiento y resultados de la implementación de los ERR en el contexto hospitalario, con énfasis en los servicios de cirugía ginecológica y atención obstetricia. Materiales y métodos: Se llevó a cabo una búsqueda en las bases de datos de literatura médica Medline vía Pubmed, Embase vía OVID, LILACS, Cochrane Library y Open Gray. Se incluyeron estudios observacionales descriptivos y analíticos, estudios experimentales y estudios cualitativos que incluyeron ERR en instituciones de salud de alta complejidad u hospitales universitarios. Dos investigadores seleccionaron los estudios y extrajeron los datos respecto a la conformación, funcionamiento, los criterios de activación del equipo, los tiempos de respuesta o las herramientas de evaluación de su desempeño. No se hicieron restricciones de fecha o estado de publicación. Se incluyeron estudios en inglés, español y portugués. Se hace síntesis narrativa de los hallazgos. Resultados: La búsqueda arrojó 15,833 títulos, un total de 15 estudios cumplieron con los criterios de inclusión. Solo un estudio menciona el uso de los ERR en servicios de obstetricia. La conformación de los ERR es multidisciplinaria y están disponibles al menos 12 horas cada día. Sus funciones son la identificación temprana de pacientes con deterioro de la condición, especialmente en áreas por fuera de la unidad de cuidados intensivos y de pacientes con condiciones subyacentes o eventos desencadenantes que aumentan el riesgo de paro cardíaco. Además, implementan intervenciones rápidas multifacéticas que incluyen tratamientos farmacológicos, procedimientos cardiopulmonares, y desarrollan actividades de comunicación y formación. Se dispone de herramientas para la activación y evaluación de los procesos asistenciales. Conclusión: La estructura y las funciones del ERR están claramente descritas, lo que permite que sean ensamblados en hospitales de alta complejidad. Se deben realizar más investigaciones sobre los beneficios y riesgos del uso de los ERR para mitigar los daños en pacientes con EREND y comparar la efectividad y seguridad entre la activación de códigos y las estrategias de ERR en los servicios de obstetricia.


Abstract Introduction and Objective: A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods: A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results: Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion: The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.


Subject(s)
Humans , Female , Hospital Rapid Response Team , Risk Management , Patient Safety , Clinical Deterioration , Early Warning Score
4.
Säo Paulo med. j ; 139(2): 170-177, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181006

ABSTRACT

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pneumonia/diagnosis , Pneumonia/epidemiology , Triage/methods , Risk Assessment/methods , Emergency Service, Hospital/statistics & numerical data , Early Warning Score , COVID-19/therapy , Turkey , Uremia/etiology , Uremia/epidemiology , Blood Pressure , Retrospective Studies , Respiratory Rate/physiology , Pandemics , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/epidemiology
5.
Arch. argent. pediatr ; 118(6): 399-404, dic 2020. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1146064

ABSTRACT

Introducción. La detección temprana del deterioro clínico en pacientes internados posibilita mejorar la calidad de atención médica. Las escalas Pediatric Early Warning Score (PEWS) predicen este deterioro dentro de las primeras 24 h de aplicadas. Estudios previos avalan estas herramientas.Objetivo. Evaluar la utilidad de la escala B-PEWS(Brighton PEWS) para predecir el deterioro clínico en niños internados, en un hospital pediátrico de la Ciudad de Buenos Aires.Población y métodos. Diseño de corte transversal. Incluyó todas las historias clínicas de pacientes de 1 mes a 18 años hospitalizados en áreas de hospitalización indiferenciada, desde el 1 de marzo al 31 de agosto de 2018. Variable de predicción: valor de B-PEWS (≤ 3 y ≥ 4 puntos). Variable de resultado: deterioro clínico dentro de las 24 horas. Análisis de variables categóricas mediante prueba de chi2 y cálculo de valores de clivaje. Como medida de asociación, se usó riesgo relativo. Se realizó análisis de curva ROCy análisis de punto óptimo mediante índice de Youden, tomando la escala de manera continua.Resultados. Se analizaron 518 historias clínicas. Cuarenta pacientes presentaron deterioro clínico; 37 con B-PEWS ≥ 4, y 3 con B-PEWS ≤ 3 (RR 56,36; IC 95 %: 17,76-178,89; p < 0,01). Sensibilidad: el 92,5 %; especificidad: el 88,3 %; valor predictivo positivo: el 39,8 %; negativo: el 99,3 %; razón de verosimilitud positiva: 7,91; razón de verosimilitud negativa: 0,08. AUC: 0,94 (IC 95 %: 0,89-0,98).Conclusión. La escala B-PEWS demostró ser útil para predecir el deterioro clínico en niños hospitalizados


Introduction. The early detection of clinical deterioration in hospitalized patients helps to improve the quality of care. The pediatric early warning score (PEWS) system predicts such deterioration in the first 24 hours of administration. Prior studies support the use of these tools.Objective. To assess the usefulness of the Brighton PEWS (B-PEWS) for the prediction of clinical deterioration among hospitalized children at a children's hospital in the Autonomous City of Buenos Aires.Population and methods. Cross-sectional study. The medical records of all patients aged 1 month to 18 years admitted to any hospitalization ward between March 1st and August 31st, 2018 were included. Predictive outcome measure: B-PEWS score (≤ 3 and ≥ 4 points). Outcome variable: clinical deterioration in the first 24 hours. Categorical outcome measures were analyzed with the χ² test and screening values were estimated. The relative risk was used as a measure of association. A ROC curve analysis and an optimal cut-point analysis according to the Youden index were done considering the score in a continuous manner.Results. A total of 518 medical records were reviewed. Forty patients had clinical deterioration; the B-PEWS score was ≥ 4 in 37 patients and ≤ 3 in 3 (relative risk: 56.36; 95 % confidence interval: 17.76-178.89; p < 0.01). Sensitivity: 92.5 %; specificity: 88.3 %; positive predictive value: 39.8 %; negative predictive value: 99.3 %; positive likelihood ratio: 7.91; negative likelihood ratio: 0.08. AUC:0.94 (95 % confidence interval: 0.89-0.98).Conclusion. The B-PEWS demonstrated to be useful to predict clinical deterioration in hospitalized children.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Clinical Deterioration , Early Warning Score , Child, Hospitalized , Cross-Sectional Studies , Health Status Indicators
6.
Rev. bras. ter. intensiva ; 32(3): 439-443, jul.-set. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138501

ABSTRACT

RESUMO Objetivo: Verificar se há associação entre o Modified Early Warning Score antes da transferência da emergência para enfermaria e o óbito ou a admissão na unidade de terapia intensiva em 30 dias. Métodos: Trata-se de estudo de coorte histórica desenvolvido em hospital de alta complexidade do Sul do Brasil com pacientes transferidos da emergência para a enfermaria entre os meses de janeiro e junho de 2017. Foram coletados: variáveis sociodemográficas, comorbidades pelo índice de Charlson, motivo da internação hospitalar, pontuação do Modified Early Warning Score no momento da transferência, internação na unidade de terapia intensiva, atendimento pelo Time de Resposta Rápida, mortalidade em 30 dias e mortalidade hospitalar. Resultados: Foram incluídos 278 pacientes no estudo. Em relação ao Modified Early Warning Score, os pacientes com óbito em 30 dias apresentaram escore significativamente maior do que os pacientes sobreviventes nesse período (2,0 [1,0 - 3,0] versus 1,0 [1,0 - 2,0], respectivamente; p = 0,006). As áreas sob a curva Característica de Operação do Receptor para óbito em 30 dias e para admissão na UTI foram 0,67 (0,55 - 0,80; p = 0,012) e 0,72 (0,59 - 0,84; p = 0,02), respectivamente, com ponto de corte do Modified Early Warning Score ≥ 2. Na regressão de Cox, o Modified Early Warning Score apresentou associação independente com mortalidade em 30 dias, após ajuste multivariável (hazard ratio 2,91; intervalo de confiança de 95% 1,04 - 8,13). Conclusão: O Modified Early Warning Score antes da transferência intra-hospitalar da emergência para enfermaria está associado com admissão na unidade de terapia intensiva e óbito em 30 dias. Calcular o Modified Early Warning Score pode ser um indicador importante para acompanhamento desses pacientes, permitindo ações específicas da equipe receptora.


Abstract Objective: To verify whether there is an association between the Modified Early Warning Score before the transfer from the emergency room to the ward and death or admission to the intensive care unit within 30 days. Methods: This is a historical cohort study conducted in a high-complexity hospital in southern Brazil with patients who were transferred from the emergency room to the ward between January and June 2017. The following data were collected: sociodemographic variables; comorbidities, as determined by the Charlson index; reason for hospitalization; Modified Early Warning Score at the time of transfer; admission to the intensive care unit; care by the Rapid Response Team; mortality within 30 days; and hospital mortality. Results: A total of 278 patients were included in the study. Regarding the Modified Early Warning Score, patients who died within 30 days had a significantly higher score than surviving patients during this period (2.0 [1.0 - 3.0] versus 1.0 [1.0 - 2.0], respectively; p = 0.006). The areas under the receiver operating characteristic curve for death within 30 days and for ICU admission were 0.67 (0.55 - 0.80; p = 0.012) and 0.72 (0.59 - 0.84; p = 0.02), respectively, with a Modified Early Warning Score cutoff of ≥ 2. In the Cox regression, the Modified Early Warning Score was independently associated with mortality within 30 days after multivariate adjustment (hazard ratio 2.91; 95% confidence interval 1.04 - 8.13). Conclusion: The Modified Early Warning Score before intrahospital transfer from the emergency room to the ward is associated with admission to the intensive care unit and death within 30 days. The Modified Early Warning Score can be an important indicator for monitoring these patients and can prompt the receiving team to take specific actions.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Patient Transfer/statistics & numerical data , Hospital Mortality , Early Warning Score , Intensive Care Units/statistics & numerical data , Time Factors , Brazil , Retrospective Studies , Cohort Studies , Emergency Service, Hospital/statistics & numerical data , Hospital Rapid Response Team , Hospitalization/statistics & numerical data
7.
Rev. bras. ter. intensiva ; 32(2): 301-307, Apr.-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138479

ABSTRACT

RESUMO Objetivo: Avaliar a hipótese de que o Modified Early Warning Score (MEWS) por ocasião da alta da unidade de terapia intensiva associa-se com readmissão, e identificar o nível desse escore que prediz com maior confiabilidade a readmissão à unidade de terapia intensiva dentro de 48 horas após a alta. Métodos: Este foi um estudo observacional retrospectivo a respeito do MEWS de pacientes que receberam alta da unidade de terapia intensiva. Comparamos dados demográficos, escores de severidade, características da doença crítica e MEWS de pacientes readmitidos e não readmitidos. Identificamos os fatores associados com a readmissão em um modelo de regressão logística. Construímos uma curva Característica de Operação do Receptor para o MEWS na predição da probabilidade de readmissão. Por fim, apresentamos o critério ideal com maior sensibilidade e especificidade. Resultados: A taxa de readmissões foi de 2,6%, e o MEWS foi preditor significante de readmissão, juntamente do tempo de permanência na unidade de terapia intensiva acima de 10 dias e traqueostomia. A curva Característica de Operação do Receptor relativa ao MEWS para predizer a probabilidade de readmissão teve área sob a curva de 0,82, e MEWS acima de 6 teve sensibilidade de 0,78 (IC95% 0,66 - 0,9) e especificidade de 0,9 (IC95% 0,87 - 0,93). Conclusão: O MEWS associa-se com readmissão à unidade de terapia intensiva, e o escore acima de 6 teve excelente precisão como preditor prognóstico.


ABSTRACT Objective: To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge. Methods: This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity. Results: The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93). Conclusion: The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Patient Readmission/statistics & numerical data , Critical Illness , Early Warning Score , Intensive Care Units/statistics & numerical data , Patient Discharge , Prognosis , Severity of Illness Index , Tracheostomy/statistics & numerical data , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Length of Stay
8.
Rev. bras. enferm ; 72(6): 1428-1434, Nov.-Dec. 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1042185

ABSTRACT

ABSTRACT Objective: To evaluate the performance of the modified early warning score (Mews) in a nursing ward for patients in clinical deterioration. Method: This is an analytical, quantitative and predictive study. Mews' parameters (systolic blood pressure, heart rate, respiratory rate, temperature and level of consciousness) were evaluated every six hours. The following events were reported: death, cardiopulmonary arrest and transfer to intensive care. The evaluations were performed in a hospital of reference in the state of São Paulo, Brazil. Results: A total of 300 patients were included (57 ± 18 years old, males: 65%). There number of combined events was observed to be greater the higher the score's value (00%; 00%; 01; 09%; 19%; 28%; 89%, respectively, for Mews 0; 1; 2; 3; 4; 5 and 6; p < 0.0001). Mews ≥ 4 was the most appropriate cut-off point for prediction of these events (sensitivity: 87%, specificity: 85% and accuracy: 0.86). Conclusion: Mews properly measured the occurrence of severe events in hospitalized patients of a Brazilian public hospital's nursing ward. Mews ≥ 4 seems to be the most appropriate cut-off point for prediction of these events.


RESUMEN Objetivo: Evaluar el desempeño de la puntuación de alerta temprana modificada (Mews) en una enfermería de pacientes con deterioro clínico. Método: Se trata de un estudio analítico, cuantitativo y predictivo. Los parámetros Mews (presión arterial sistólica, frecuencia cardíaca, frecuencia respiratoria, temperatura y nivel de conciencia) se evaluaron cada 6 horas. Se registraron los siguientes eventos: muerte, parada cardiorrespiratoria y transferencia para la terapia intensiva. Las evaluaciones se realizaron en un hospital de referencia del interior del estado de São Paulo. Resultados: Participaron 300 pacientes (57 ± 18 años; sexo masculino: 65%). Se observó un número creciente de eventos asociados según el mayor valor de la puntuación (00%; 00%; 01%; 09%; 19%; 28%; 89%, respectivamente, para los Mews 0; 1; 2; 3; 4; 5 y 6; p <0,0001). Los Mews ≥ 4 fueron el punto de corte más adecuado para la predicción de estos eventos (sensibilidad: 87%; especificidad: 85%; y exactitud: 0,86). Conclusión: Los Mews permitieron estimar adecuadamente la ocurrencia de eventos graves en pacientes hospitalizados en la enfermería de un hospital público brasileño. Los Mews ≥ 4 parece ser el punto de corte más adecuado para predecirlos.


RESUMO Objetivo: Avaliar o desempenho do escore de alerta precoce modificado (Mews) em uma enfermaria de pacientes em deterioração clínica. Método: Trata-se de um estudo analítico, quantitativo e preditivo. Os parâmetros do Mews (pressão arterial sistólica, frequência cardíaca, frequência respiratória, temperatura e nível de consciência) foram avaliados de 6 em 6 horas. Os seguintes eventos foram registrados: óbito, parada cardiorrespiratória e transferência para terapia intensiva. As avaliações foram realizadas em um hospital de referência do interior do estado de São Paulo. Resultados: Foram incluídos 300 pacientes (57 ± 18 anos, sexo masculino: 65%). Observou-se número crescente de eventos combinados de acordo com o maior valor do escore (00%; 00%; 01%; 09%; 19%; 28%; 89%, respectivamente, para os Mews 0; 1; 2; 3; 4; 5 e 6; p < 0,0001). Mews ≥ 4 foi o ponto de corte mais adequado para predição destes eventos (sensibilidade: 87%, especificidade: 85% e acurácia: 0,86). Conclusão: Mews mensura adequadamente a ocorrência de eventos graves em pacientes hospitalizados em enfermaria de um hospital público brasileiro. Mews ≥ 4 parece ser o ponto de corte mais adequado para predição destes eventos.


Subject(s)
Humans , Male , Female , Hospital Rapid Response Team/organization & administration , Clinical Deterioration , Early Warning Score , Time Factors , Blood Pressure , Body Temperature , Brazil , Patient Transfer , Sensitivity and Specificity , Consciousness , Death , Emergency Service, Hospital , Respiratory Rate , Heart Arrest/diagnosis , Heart Rate , Hospitals, Public , Intensive Care Units , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL