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Can binary early warning scores perform as well as standard early warning scores for discriminating a patient’s risk of cardiac arrest, death or unanticipated intensive care unit admission?

机译:二元预警评分能否与标准早期预警评分一致,以区分患者心脏骤停,死亡或意外重症监护病房入院的风险?

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摘要

- Although the weightings to be summed in an early warning score (EWS) calculation are small, calculation and other errors occur frequently, potentially impacting on hospital efficiency and patient care. Use of a simpler EWS has the potential to reduce errors. - We truncated 36 published ‘standard’ EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. Using 1564,153 vital signs observation sets from 68,576 patient care episodes, we compared the discrimination (measured using the area under the receiver operator characteristic curve—AUROC) of each standard EWS and its truncated ‘binary’ equivalent. - The binary EWSs had lower AUROCs than the standard EWSs in most cases, although for some the difference was not significant. One system, the binary form of the National Early Warning System (NEWS), had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate. - The performance of Binary NEWS is only exceeded by that of standard NEWS. It may be that Binary NEWS, as a simplified system, can be used with fewer errors. However, its introduction could lead to significant increases in workload for ward and rapid response team staff. The balance between fewer errors and a potentially greater workload needs further investigation.
机译:-尽管在预警分数(EWS)计算中求和的权重很小,但是计算和其他错误经常发生,可能会影响医院的效率和患者护理。使用更简单的EWS可以减少错误。 -我们截断了36个已发布的“标准” EWS,因此对于每个组件,只有两个分数是可能的:当标准EWS得分为0时为0,而当标准EWS得分大于0时为1。使用68,576中的1564,153个生命体征观察集在患者护理事件中,我们比较了每个标准EWS及其截短的“二进制”等价项的辨别力(使用接收器操作员特征曲线下的面积-AUROC测量)。 -在大多数情况下,二进制EWS的AUROC低于标准EWS,尽管在某些情况下差异并不明显。一种系统,即国家早期预警系统(NEWS)的二进制形式,具有比所有标准EWS更好的区分能力,除了NEWS。总体而言,触发值为3的二进制NEWS可以检测到与触发为5的NEWS所检测到的不良结果一样多的结果,但需要更高的触发率15%。 -二进制新闻的性能仅超过标准新闻的性能。作为简化系统,二进制新闻可能使用的错误更少。但是,引入它可能会导致病房和快速反应团队人员的工作量显着增加。更少的错误和可能更大的工作量之间的平衡需要进一步研究。

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