>Year 2018, Issue 3
Centeno SMA, Monares ZE, Galindo MCA, Cruz LJ, Santana HGP, Cebrián GR
A comparation of rapid response scales: Vital signs, CART, qSOFA and super SIRS
Rev Asoc Mex Med Crit y Ter Int 2018; 32 (3)
PDF: 177.23 Kb.
Introduction: Rapid response teams can decrease mortality and the number of cardiorespiratory events outside critical areas. There is risk of a suboptimal team or over activation. It is intended to find the most useful tool for the initial assessment of patients in a rapid response team, calculating the performance of certain tools to detect the requirement of transfer to an intensive care unit and mortality, as well as the evaluation of the cases of rescue failure.
Material and methods: Retrospective, observational study in which every adult patient evaluated by the rapid response team and every rescue failure were included, capturing demographic variables, vital signs and outcome (transfer to the intensive care unit and mortality). Subsequently, qSOFA, CART and Super SIRS were calculated for every patient, along with the performance of such scales for the detection of transfer and mortality using ROC curves. Odds ratios for mortality and rescue failure were calculated; also, the general number needed to treat.
Results: A total of 158 patients were included, 40 transfers to the intensive care unit (25.3%), 10 deaths (6.3%) and eight rescue failures (5.1%). The CART scale showed the highest performance in the detection of transfer and mortality (areas under the curve: 0.63 y 0.66, respectively, p ‹ 0.05). A rescue failure increased the risk of mortality 61 times, and the number needed to treat was two.
Conclusion: The CART scale is the most effective tool for the detection of high risk patients in our population; it is imperative to avoid rescue failure due to the high risk of mortality.
||Rapid response, scales, mortality.
Jung B, Daurat A, De Jong A, Chanques G, Mahul M, Monnin MJ, et al. Rapid response team and hospital mortality in hospitalized patients. Intensive Care Med. 2016;42:494-504.
Tirkkonen J, Tamminen T, Skrifvars MB. Outcome of adult patients attended by rapid response teams: a systematic review of the literature. Resuscitation. 2017;112:43-52.
Gu WJ, Wang F, Bakker J, Tang L, Liu JC. The effect of goal-directed therapy on mortality in patients with sepsis-earlier is better: a meta-analysis of randomized controlled trials. Crit Care. 2014;18(5):570.
Chan P, Peake S, Bellomo R, Jones D. Improving the recognition of, and response to in-hospital sepsis. Curr Infect Dis Rep. 2016;18(7):20.
Leisman DE, Doerfler ME, Ward MF, Masick KD, Wie BJ, Gribben JL, et al. Survival benefit and cost savings from compliance with a simplified 3-hour sepsis bundle in a series of prospective, multisite, observational cohorts. Crit Care Med. 2017;45(3):395-406.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-810.
Churpek MM, Yuen TC, Park SY, Meltzer DO, Hall JB, Edelson DP. Derivation of a cardiac arrest prediction model using ward vital signs. Crit Care Med. 2012;40(7):2102-2108.
Churpek MM, Snyder A, Sokol S, Pettit NN, Edelson DP. Investigating the impact of different suspicion of infection criteria on the accuracy of quick sepsis-related organ failure assessment, systemic inflammatory response syndrome and early warning scores. Crit Care Med. 2017;45(11):1805-1812.
Curry JP, Jungquist CR. A critical assessment of monitoring practices patient deterioration, and alarm fatigue on in patient wards: a review. Patient Saf Surg. 2014;8:29.
Chen J, Bellomo R, Flabouris A, Hillman K, Assareh H, Ou L. Delayed emergency team calls and associated hospital mortality: a multicenter study. Crit Care Med. 2015;43(10):2059-2065.
Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP. Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients. Am J Respir Crit Care Med. 2015;192(8):958-964.
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521-526.
Churpek MM, Yuen TC, Winslow C, Robicsek AA, Meltzer DO, Gibbons RD, et al. Multicenter development and validation of a risk stratification tool for ward patients. Am J Respir Crit Care Med. 2014;190(6):649-655.
>Year 2018, Issue 3