Comparison of the National Early Warning Scores and Rapid Emergency Medicine Scores with the APACHE II Scores as a Prediction of Mortality in Patients with Medical Emergency Team Activation: A Single-centre Retrospective Cohort Study
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Nov 06, 2021
About this article
Article Category: Research article
Published Online: Nov 06, 2021
Page range: 283 - 289
Received: Mar 18, 2021
Accepted: Oct 10, 2021
DOI: https://doi.org/10.2478/jccm-2021-0040
Keywords
© 2021 Junpei Haruna, Hiroomi Tatsumi, Satoshi Kazuma, Hiromitsu Kuroda, Yuya Goto, Wakiko Aisaka, Hirofumi Terada, Tomoko Sonoda, Yoshiki Masuda, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig. 1
Fig. 2
Comparison of vital signs and physical status in the survivor group and the non-survivor group
| Total (n=196) | Survivor group (n=152) | Non-survivor group (n=44) | p-value | |
|---|---|---|---|---|
| Body temperature (°C), [Median, IQR] | 37.2(36.5-37.5) | 36.8(36.5-37.4) | 37.0(36.7-37.7) | 0.95 |
| Pulse rate (/min), [Median, IQR] | 100(80-120) | 92(80-120) | 110(80-121) | 0.15 |
| Respiratory rate (/min), [Median, IQR] | 27(20-30) | 24(20-30) | 27(20-31) | 0.10 |
| SpO2 (%), [Median, IQR] | 95(88-98) | 94(90-98) | 90(85-95) | 0.02 |
| Systolic arterial pressure (mmHg), [Median, IQR] | 109(74-130) | 100(74-130) | 101(73-133) | 0.88 |
| Mean arterial pressure (mmHg), [Median, IQR] | 76(52-89) | 71(51-89) | 72(39-90) | 0.98 |
| Glasgow Coma Scale≤8, n. (%) | 35 (18) | 21(13) | 14(31) | 0.01 |
| Oxygenation, n. (%) | 88 (44) | 64(42) | 24(54) | 0.60 |
| Altered mental status, |
58(29) | 44(28) | 14(31) | 0.86 |
| AVPU score, |
||||
| Alert | 100(51) | 88(58) | 12(27) | <0.01 |
| Verbal | 41(21) | 29(19) | 12(27) | 0.29 |
| Pain | 32(16) | 22(14) | 10(23) | 0.06 |
| Unresponsive | 23(12) | 13(9) | 10(23) | 0.02 |
Comparison of the predictive power and clinical utility of the APACHE II score, NEWS, and REMS in 28-day mortality
| Discrimination AUC (95% CI) | APACHE II vs p-value EWS | Clinical utility |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| Optimal cut-off | Sensitivity | Specificity | PPV | NPV | PLR | NLR | |||
| APACHE II | 0.76 (0.67 | -0.83) | 18 | 0.89 | 0.50 | 0.34 | 0.94 | 2.52 | 0.45 |
| NEWS | 0.67 (0.59-0.75) | 0.10 | 7 | 0.70 | 0.62 | 0.35 | 0.88 | 1.84 | 0.76 |
| REMS | 0.70 (0.61-0.78) | 0.26 | 11 | 0.47 | 0.81 | 0.42 | 0.84 | 0.95 | 0.65 |
Median and IQR of the probability of death using the APACHE II score, NEWS, and REMS
| Total (n=196) | Survivor group (n=152) | Non-survivor group (n=44) | p-value | |
|---|---|---|---|---|
| APACHE II Median, IQR] | 21(15-26) | 19(14-24) | 25(21-31) | <0.01 |
| NEWS [Median, IQR] | 7(6-9) | 7(5-9) | 9(7-10) | <0.01 |
| REMS [Median, IQR] | 9(6-12) | 9(6-11) | 11(8-13) | <0.01 |
Patient characteristics
| Total (n=196) | Survivors (n=152) | Non-survivors (n=44) | p-value | |
|---|---|---|---|---|
| Age (years), [Median, IQR] | 68(57-76) | 67.5(56-76) | 67.7(63-77) | 0.18 |
| Male, |
152(77.5) | 121(79.6) | 31(70.4) | 0.21 |
| Transferred to ICU post-MET, n (%) | 134(68.4) | 96(49.0) | 38(86.4) | <0.01 |
| CCI, [Mean (SD)] | 1.05(1.44) | 1.06 (1.48) | 0.97(1.29) | 0.94 |
| SOFA, [Median, IQR] | 6(4-8) | 5(4-7) | 9(7-12) | <0.01 |
| Illness category, surgical, n (%) | 122(62.2) | 98(64.5) | 24(54.5) | 0.29 |
| Reason of MET triggers, |
||||
| Respiratory | 85(43) | 62(41) | 23(52) | 0.22 |
| Cardiovascular | 45(23) | 37(24) | 8(18) | 0.39 |
| Neurology | 18(9) | 15(10) | 3(7) | 0.38 |
| Haemorrhage | 15(8) | 12(8) | 3(7) | 0.06 |
| Others | 33(17) | 26(17) | 7(16) | 0.85 |