Summary
Objective
To evaluate the ability of pre-defined clinical criteria to identify patients who
subsequently suffer cardiac arrest, unplanned intensive care unit admission or unexpected
death; to determine the ability of modified criteria to identify these patients.
Design
Nested, matched case–control study.
Setting
Seven Australian public hospitals.
Patients and participants
Four hundred and fifty cases and 520 controls matched for age, sex, hospital, and
hospital ward.
Interventions
None.
Measurements and results
Highest and lowest respiratory and heart rates, lowest systolic blood pressure, presence
of threatened airway, seizures or decrease in Glasgow Coma Scale score of greater
than two points and incidence of the three adverse events were measured. Combining
a heart rate greater than 140, respiratory rate greater than 36, a systolic blood
pressure less than 90 mmHg and a greater than two point reduction in the Glasgow Coma Scale identified adverse
events with a sensitivity of 49.1% (44.4–53.8%), specificity of 93.7% (91.2–95.6%),
and positive predictive value of 9.8% (8.7–11.1%). Adding threatened airway, seizures,
low respiratory rate and low heart rate did not substantially improve sensitivity
(50.4%; 45.7–55.2%). After modifying the cut-off values for respiratory rate, heart
rate and systolic blood pressure, the best achievable positive predictive value remained
below 16%.
Conclusions
In combination, the respiratory rate, heart rate, systolic blood pressure, and level
of consciousness identify patients at risk of cardiac arrest, unplanned intensive
care admission or unexpected death with high specificity; however the sensitivity
and positive predictive value are relatively low, even after modification of the activation
criteria cut-off values.
Keywords
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Article info
Publication history
Accepted:
August 17,
2006
Received in revised form:
August 10,
2006
Received:
March 25,
2006
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.08.020.
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
