Abstract
There is increasing interest in predicting and avoiding cardiac arrest in hospitalized patients. Multiple studies have used vital signs or scores based upon them, such as the Modified Early Warning Score (MEWS). Scoring systems that measure supportive care, such as the Sequential Organ Failure Assessment (SOFA) and the 28-item Therapeutic Interventions Scoring System (TISS-28) might be superior to systems used in previous studies. This study was performed to determine if a system using SOFA and/or TISS would be superior in detecting clinical deterioration prior to cardiac arrest.Using a retrospective chart review, MEWS, SOFA and TISS-28 scores were calculated for twenty patients at baseline and then in the 24 hours prior to their cardiac arrest. Supportive interventions and nursing care (SOFA and TISS-28) changed more than measures of physiology (MEWS) in the period prior to cardiac arrest, likely due to the fact that vital sign deterioration can be delayed by supportive measures. These results support the idea that a SOFA and/or TISS-28 scoring system might be superior to the MEWS, which could be used to make hospital rapid response teams more effective.
Highlights
Cardiac arrest in hospitalized patients outside the intensive care unit (ICU) carries a high mortality
A vital sign-based tool is appealing for general ward patients, it is limited by the quality of the data, with respect to respiratory rate and mental status, which are poorly assessed and documented outside the intensive care unit
In the remaining 17 patients, the Sequential Organ Failure Assessment (SOFA) score increased from 1.29±0.40 at baseline to 1.76±0.45 (p=0.03) on the calendar day before the event, representing an increase of 36%, while the TISS-28 increased from 9.9 to 15.0 (p=0.04), representing a 52% increase
Summary
Cardiac arrest in hospitalized patients outside the intensive care unit (ICU) carries a high mortality. The challenge lies in developing robust algorithms to predict cardiac arrests in order to better target interventions. The Modified Early Warning Score (MEWS) is one attempt at a risk prediction algorithm. This scale, which assigns point values for abnormal vital signs or mental status assessments, has been used to predict requirement for hospital admission in emergency department patients[9] and to predict hospital mortality[10]. A vital sign-based tool is appealing for general ward patients, it is limited by the quality of the data, with respect to respiratory rate and mental status, which are poorly assessed and documented outside the intensive care unit. Physiology-based tools do not take into account what has been done to the patient to maintain that physiology, such as the use of supplemental oxygen to maintain oxygen saturation or vasopressor agents to maintain blood pressure
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