Risk assessment in the first fifteen minutes a prospective cohort study of a simple physiological scoring system in the emergency department 英文参考文献.docVIP

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Risk assessment in the first fifteen minutes a prospective cohort study of a simple physiological scoring system in the emergency department 英文参考文献.doc

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Risk assessment in the first fifteen minutes a prospective cohort study of a simple physiological scoring system in the emergency department 英文参考文献

Merzetal.CriticalCare2011,15:R25 /content/15/1/R25 RESEARCH OpenAccess Riskassessmentinthefirstfifteenminutes:a prospectivecohortstudyofasimplephysiological scoringsystemintheemergencydepartment TobiasMMerz1*,RetoEtter1,LudgerMende1,DanielBarthelmes1,JanWiegand1,LucaMartinolli2,JukkaTakala1 Abstract Introduction:Thesurvivalofpatientsadmittedtoanemergencydepartmentisdeterminedbytheseverityof acuteillnessandthequalityofcareprovided.Thehighnumberandthewidespectrumofseverityofillnessof admittedpatientsmakeanimmediateassessmentofallpatientsunrealistic.Theaimofthisstudyistoevaluatea scoringsystembasedonreadilyavailablephysiologicalparametersimmediatelyafteradmissiontoanemergency department(ED)forthepurposeofidentificationofat-riskpatients. Methods:Thisprospectiveobservationalcohortstudyincludes4,388consecutiveadultpatientsadmittedviathe EDofa960-bedtertiaryreferralhospitaloveraperiodofsixmonths.Occurrenceofeachofsevenpotentialvital signabnormalities(threattoairway,abnormalrespiratoryrate,oxygensaturation,systolicbloodpressure,heartrate, lowGlasgowComaScaleandseizures)wascollectedandaddeduptogeneratethevitalsignscore(VSS).VSSinitial wasdefinedastheVSSinthefirst15minutesafteradmission,VSSmax asthemaximumVSSthroughoutthestayin ED.Occurrenceofsinglevitalsignabnormalitiesinthefirst15minutesandVSSinitial andVSSmax wereevaluatedas potentialpredictorsofhospitalmortality. Results:Logisticregressionanalysisidentifiedallevaluatedsinglevitalsignabnormalitiesexceptseizuresand abnormalrespiratoryratetobeindependentpredictorsofhospitalmortality.IncreasingVSSinitial andVSSmax were significantlycorrelatedtohospitalmortality(oddsratio(OR)2.80,95%confidenceinterval(CI)2.50to3.14,P 0.0001forVSSinitial;OR2.36,95%CI2.15to2.60,P0.0001forVSSmax).ThepredictivepowerofVSSwashighestif collectedinthefirst15minutesafterEDadmission(logrankChi-square468.1,P0.0001forVSSinitial;,logrankChi square361.5,P0.0001forVSSmax ). Conclusions:VitalsignabnormalitiesandVSScollectedinthefirstminut