Manual centile-based early warning scores derived from statistical distributions of observational vital-sign data.
Resuscitation
; 129: 55-60, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29879432
ABSTRACT
AIMS OF STUDY To develop and validate a centile-based early warning score using manually-recorded data (mCEWS). To compare mCEWS performance with a centile-based early warning score derived from continuously-acquired data (from bedside monitors, cCEWS), and with other published early warning scores. MATERIALS AND METHODS:
We used an unsupervised approach to investigate the statistical properties of vital signs in an in-hospital patient population and construct an early-warning score from a "development" dataset. We evaluated scoring systems on a separate "validation" dataset. We assessed the ability of scores to discriminate patients at risk of cardiac arrest, unanticipated intensive care unit admission, or death, each within 24â¯h of a given vital-sign observation, using metrics including the area under the receiver-operating characteristic curve (AUC).RESULTS:
The development dataset contained 301,644 vital sign observations from 12,153 admissions (median age (IQR) 63 (49-73); 49.2% females) March 2014-September 2015. The validation dataset contained 1,459,422 vital-sign observations from 53,395 admissions (median age (IQR) 68 (48-81), 51.4% females) October 2015-May 2017. The AUC (95% CI) for the mCEWS was 0.868 (0.864-0.872), comparable with the National EWS, 0.867 (0.863-0.871), and other recently proposed scores. The AUC for cCEWS was 0.808 (95% CI, 0.804-0.812). The improvement in performance in comparison to the continuous CEWS was mainly explained by respiratory rate threshold differences.CONCLUSIONS:
Performance of an EWS is highly dependent on the database from which itis derived. Our unsupervised statistical approach provides a straightforward, reproducible method to enable the rapid development of candidate EWS systems.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medição de Risco
/
Sinais Vitais
/
Parada Cardíaca
/
Hospitalização
/
Unidades de Terapia Intensiva
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Resuscitation
Ano de publicação:
2018
Tipo de documento:
Article