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Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score
Author(s) -
TIRKKONEN JOONAS,
OLKKOLA KLAUS T.,
HUHTALA HEINI,
TENHUNEN JYRKI,
HOPPU SANNA
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12277
Subject(s) - medicine , odds ratio , confidence interval , confounding , population , logistic regression , comorbidity , early warning score , prospective cohort study , demography , cohort study , emergency medicine , environmental health , sociology
Background To activate the hospital's medical emergency team ( MET ), either conventional dichotomised activation criteria or an early warning scoring system may be used. The relative performance of these different activation patterns to discriminate high risk patients in a heterogenic general ward population after adjustment for multiple confounding factors has not been evaluated. We aimed to evaluate the dichotomised activation criteria used at our institution and the recently published national early warning score ( NEWS , U nited K ingdom). Materials and Methods Prospective point prevalence study at a university hospital in F inland. On two separate days, the vital signs of all adult patients without treatment limitations were measured. Data on cumulative comorbidity ( C harlson comorbidity index), age, gender, admission characteristics and subsequent mortality were collected. Univariate and multivariate logistic regression models were used for unadjusted and adjusted performance testing.Results The cohort consisted of 615 patients. The dichotomised activation criteria were not associated with in‐hospital serious adverse events (odds ratio 1.87, 95% confidence interval 0.55–6.30) or 30‐day mortality (2.13, 0.79–5.72) after adjustments. For a NEWS of seven or more (the suggested trigger level for immediate MET activation), the adjusted odds ratios for the above mentioned outcomes were 7.45 (2.39–23.3) and 11.4 (4.40–29.6), respectively. Unlike the dichotomised activation criteria, NEWS was also independently associated with a higher 60‐ and 180‐day mortality after adjustments. Conclusions NEWS discriminates high risk patients in a heterogenic general ward population independently of multiple confounding factors. The conventional dichotomised activation criteria were not able to detect high risk patients.