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首页> 外文期刊>Resuscitation. >Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting.
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Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting.

机译：紧急情况和紧急响应的迹象（SOCCER）：用于预测住院环境中不良事件的模型。

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BACKGROUND: Emergency response systems (ERS) are based on a set of triggers used to identify patients "at risk". This study aimed to establish the association between recordings of disturbed physiological variables and adverse events. METHODS: A cross-sectional survey of 3,046 non Do Not Attempt Resuscitation (non DNAR) adult admissions in five hospitals over 14 days. Medical records were reviewed for 26 early signs (ES) and 21 late signs (LS) of critical conditions and serious adverse events (SAE): death, cardiac arrest, severe respiratory problems, or transfer to a critical care area. The LS included published medical emergency team (MET) call criteria. FINDINGS: There were 12,384 ES and 1,410 LS. The 'top five' ES and the odds (OR) for death were: base deficit -5 to -8 mmol/L=40.2 (95% C.I. 7.7-208.8), partial airway obstruction OR=38.7 (3.9-64.4), poor peripheral circulation OR=34.4 (6.8-174.0), >expected drain fluid loss OR=30.1 (6.1-148.9), pH <7.3 >7.2 OR=29.0 (3.1-268.3). For LS: urine output <200 mL in 24 h OR=188.6 (95% C.I. 30.1-1179.8), pH <7.2 OR=116.1 (7.1-1906.1), unresponsive to voice OR=34.8 (10.7-113.0), anuric OR=29.0 (3.1-268.3), base deficit <-8.0 mmol/L OR=29.0 (3.1-268.3). OR for the other SAE were similar. Pulse oximetry abnormalities were associated with all SAE. The risk for death for ES: SpO2 90-95% OR=8.1 (3.0-21.3) and LS: SpO2 <90% OR=9.0 (4.2-19.4). INTERPRETATION: Both ES and LS were associated with adverse events. This study confirms the validity of current MET call criteria but points to the need to expand them. It provides a possible explanation for the failure to demonstrate efficacy of a MET in some trials because current call criteria maybe too late in the progress of the patient's critical condition. It allows the modelling of ERS and education programmes focused on signs of critical conditions. It potentially brings together ICU outreach and ward based responses. Broader use of clinical signs, monitoring such as pulse oximetry and objective data such as blood gas results may assist early intervention and help prevent loss of life.
机译：背景：应急系统（ERS）基于一组用于识别“处于危险中”患者的触发器。这项研究旨在建立生理变量的记录与不良事件之间的联系。方法：横断面调查在14天中对五家医院的3,046例未尝试复苏（非DNAR）成人入院进行了调查。对病历和严重不良事件（SAE）的26个早期征兆（ES）和21个晚期征兆（LS）进行了病历审查，包括死亡，心脏骤停，严重的呼吸系统疾病或转移到重症监护区。 LS包括已发布的医疗急救小组（MET）呼叫标准。结果：有12,384 ES和1,410 LS。 ES的“前五名”和死亡几率（OR）为：基本赤字-5至-8 mmol / L = 40.2（95％CI 7.7-208.8），部分气道阻塞OR = 38.7（3.9-64.4），差外围循环OR = 34.4（6.8-174.0），>预期的排水量损失OR = 30.1（6.1-148.9），pH <7.3> 7.2 OR = 29.0（3.1-268.3）。对于LS：24小时内尿量<200 mL OR = 188.6（95％CI 30.1-1179.8），pH <7.2 OR = 116.1（7.1-1906.1），对语音无反应OR = 34.8（10.7-113.0），无尿OR = 29.0（3.1-268.3），碱缺乏<-8.0 mmol / L OR = 29.0（3.1-268.3）。其他SAE的OR相似。脉搏血氧饱和度异常与所有SAE相关。 ES的死亡风险：SpO2 90-95％OR = 8.1（3.0-21.3）和LS：SpO2 <90％OR = 9.0（4.2-19.4）。解释：ES和LS均与不良事件相关。这项研究证实了当前MET呼叫标准的有效性，但指出有必要对其进行扩展。它为某些试验中未能证明MET的有效性提供了可能的解释，因为当前的呼叫标准对于患者危重病情的进展可能为时已晚。它允许对ERS和教育计划进行建模，这些教育计划和培训计划着眼于危急情况。它有可能将ICU外展服务和基于病房的响应整合在一起。广泛使用临床体征，监测诸如脉搏血氧饱和度和客观数据（如血气结果）可能有助于早期干预并有助于防止生命损失。

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