BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population....BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.展开更多
目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2...目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2023年12月鹰潭市人民医院急诊科收治的82例CA后ROSC的患者,根据入院顺序,将2022年1—12月收治的41例CA后ROSC患者纳入对照组,将2023年1—12月收治的41例CA后ROSC患者纳入研究组。对照组实施常规急诊护理流程,研究组实施MEWS指导下改良急诊护理流程。比较两组48 h存活率和出院存活率;比较两组干预前和干预1、3个月后的美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分。结果:研究组48 h存活率和出院存活率分别为43.90%和34.15%,均显著高于对照组的21.95%和14.63%,差异均有统计学意义(P<0.05)。干预前,两组NIHSS评分比较,差异无统计学意义(P>0.05);干预1个月和3个月后,两组NIHSS评分均明显低于干预前,且研究组均明显低于对照组,差异均有统计学意义(P<0.05)。结论:MEWS指导下改良急诊护理流程可有效改善CA后ROSC患者神经功能和生存情况,可在临床推广应用。展开更多
目的探讨校正改良早期预警评分(modified early warning score,MEWS)联合流程优化护理对急性心力衰竭的急救效果。方法选择2021年1月至2022年6月云浮市中医院收治的90例急性心力衰竭患者作为本研究对象,采用随机数字表法分为两组,每组...目的探讨校正改良早期预警评分(modified early warning score,MEWS)联合流程优化护理对急性心力衰竭的急救效果。方法选择2021年1月至2022年6月云浮市中医院收治的90例急性心力衰竭患者作为本研究对象,采用随机数字表法分为两组,每组各45例,其中观察组45例,对照组45例。对照组行常规急救急诊干预,观察组基于对照组接受MEWS为指导的干预联合急诊流程优化护理,比较两组患者的急救效率、生命体征恢复时间、生活质量评分。结果观察组患者的分诊时间、检查时间、开通静脉通道时间、心电图时间、总抢救时间均低于对照组(P<0.05);观察组自主循环、自主呼吸、窦性心律等指标的恢复时间均低于对照组(P<0.05);干预后30d,两组患者的躯体健康、社会功能、心理功能、物质功能评分均较干预前明显提高,且观察组高于对照组(P<0.05)。结论急性心力衰竭患者急诊急救中予以MEWS为指导联合流程优化护理可促进急救效率的提升及生命体征的恢复,进而提高患者的预后及生活质量。展开更多
目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性...目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性生理Ⅱ(simplified acute physiology socreⅡ,SAPSⅡ)评分在老年危重患者中的相关性及对预后评估的准确性。方法分析入选的150例老年危重患者4种评分情况,统计患者治疗后28天病死率,比较死亡组和生存组间各评分之间是否存在差异。并分析4种评分间的相关性及利用受试者工作特征(ROC)曲线探究4种评分对患者预后的评估能力。结果 4种评分在死亡组与存活组间差异具有统计学意义。4种评分间均互呈正相关关系。通过ROC曲线分析显示:4种评分对患者预后均具有一定评估能力。APACHEⅡ评分的评估准确性优于SAPSⅡ、REMS评分、MEWS评分。SAPSⅡ评分评估准确性同样优于REMS评分和MEWS评分。REMS评分和MEWS评分评估准确性相当。结论 4种评分系统对急诊老年患者预后均具有评估意义。急诊早期MEWS评分、REMS评分与ICU病房APACHEⅡ评分、SAPSⅡ评分间对患者预后评估具有一致性。急诊早期可行MEWS评分、REMS评分评估患者病情,对可能预后不良患者早期ICU病房进行分诊,进一步根据不同情况行APACHEⅡ评分和SAPSⅡ评分动态观察、综合评估,同时各评分系统间相互结合与补充,适时采取临床相关干预措施,调整诊疗方案,挽救患者生命。展开更多
基金supported by grants from SingHealth Talent Development Fund,Singapore(TDF/CS001/2006)InfoComm Research Cluster,Nanyang Technological University,Singapore(2006ICT09)
文摘BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.
文摘目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2023年12月鹰潭市人民医院急诊科收治的82例CA后ROSC的患者,根据入院顺序,将2022年1—12月收治的41例CA后ROSC患者纳入对照组,将2023年1—12月收治的41例CA后ROSC患者纳入研究组。对照组实施常规急诊护理流程,研究组实施MEWS指导下改良急诊护理流程。比较两组48 h存活率和出院存活率;比较两组干预前和干预1、3个月后的美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分。结果:研究组48 h存活率和出院存活率分别为43.90%和34.15%,均显著高于对照组的21.95%和14.63%,差异均有统计学意义(P<0.05)。干预前,两组NIHSS评分比较,差异无统计学意义(P>0.05);干预1个月和3个月后,两组NIHSS评分均明显低于干预前,且研究组均明显低于对照组,差异均有统计学意义(P<0.05)。结论:MEWS指导下改良急诊护理流程可有效改善CA后ROSC患者神经功能和生存情况,可在临床推广应用。
文摘目的探讨校正改良早期预警评分(modified early warning score,MEWS)联合流程优化护理对急性心力衰竭的急救效果。方法选择2021年1月至2022年6月云浮市中医院收治的90例急性心力衰竭患者作为本研究对象,采用随机数字表法分为两组,每组各45例,其中观察组45例,对照组45例。对照组行常规急救急诊干预,观察组基于对照组接受MEWS为指导的干预联合急诊流程优化护理,比较两组患者的急救效率、生命体征恢复时间、生活质量评分。结果观察组患者的分诊时间、检查时间、开通静脉通道时间、心电图时间、总抢救时间均低于对照组(P<0.05);观察组自主循环、自主呼吸、窦性心律等指标的恢复时间均低于对照组(P<0.05);干预后30d,两组患者的躯体健康、社会功能、心理功能、物质功能评分均较干预前明显提高,且观察组高于对照组(P<0.05)。结论急性心力衰竭患者急诊急救中予以MEWS为指导联合流程优化护理可促进急救效率的提升及生命体征的恢复,进而提高患者的预后及生活质量。
文摘目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性生理Ⅱ(simplified acute physiology socreⅡ,SAPSⅡ)评分在老年危重患者中的相关性及对预后评估的准确性。方法分析入选的150例老年危重患者4种评分情况,统计患者治疗后28天病死率,比较死亡组和生存组间各评分之间是否存在差异。并分析4种评分间的相关性及利用受试者工作特征(ROC)曲线探究4种评分对患者预后的评估能力。结果 4种评分在死亡组与存活组间差异具有统计学意义。4种评分间均互呈正相关关系。通过ROC曲线分析显示:4种评分对患者预后均具有一定评估能力。APACHEⅡ评分的评估准确性优于SAPSⅡ、REMS评分、MEWS评分。SAPSⅡ评分评估准确性同样优于REMS评分和MEWS评分。REMS评分和MEWS评分评估准确性相当。结论 4种评分系统对急诊老年患者预后均具有评估意义。急诊早期MEWS评分、REMS评分与ICU病房APACHEⅡ评分、SAPSⅡ评分间对患者预后评估具有一致性。急诊早期可行MEWS评分、REMS评分评估患者病情,对可能预后不良患者早期ICU病房进行分诊,进一步根据不同情况行APACHEⅡ评分和SAPSⅡ评分动态观察、综合评估,同时各评分系统间相互结合与补充,适时采取临床相关干预措施,调整诊疗方案,挽救患者生命。
