Observed versus predicted hospital mortality in general wards patients assisted by a medical emergency team
1,Department of Anaesthesiology and Intensive Care Università Vita-Salute San Raffaele IRCCS San Raffaele
DOI: 10.22514/SV71.042012.7 Vol.7,Issue 1,April 2012 pp.38-42
Published: 30 April 2012
Introduction. In many countries the demand for intensive care beds exceeds their availability. The Medical Emergency Team (MET) can manage critically ill patients outside the intensive care unit (ICU). Hospital mortality rate for patients admitted to general wards and assisted by the MET was never compared to the predicted mortality for the same group of patients in an ICU setting.
Methods. Single-centre, prospective, observational study on consecutive adult patients assisted by the MET in all general wards and in the Emergency Department of a 1100-bed teaching Hospital. Patients with a ‘do-not-attempt-resuscitation’ decision were excluded.
Results. Eighty-two consecutive patients were included. Observed hospital mortality was 34.1% (28 patients), while the Simplified Acute Physiology Score II (SAPS II) predicted a mortality for the first MET visit of 17% (p=0.02). Patients tran-sferred to an ICU, but not during the first MET evaluation (delayed ICU admission), had worse than predicted outcomes, while patients immediately transferred to an ICU showed hospital mortality similar to the predicted one. The fifty patients treated for acute respiratory failure (especially those with pneumonia – 12 patients) had the worst observed/predicted hospital mortality ratio (3.0 for acute respiratory failure, p=0.02; 8.06, p=0.03 for pneumonia patients).
Conclusions. Critically ill patients who remained in general wards or who were admitted to the ICU with some delay had markedly higher hospital mortality than the SAPS II predicted hospital mortality, even if they were assisted by the MET.
medical emergency team, rapid response system, inten-sive care unit; critical care
LUCA CABRINI,GIACOMO MONTI,VALENTINA PAOLA PLUMARI,GIOVANNI LANDONI,STEFANO TURI,LAURA PASIN•PAOLO SILVANI,SERGIO COLOMBO,ALBERTO ZANGRILLO. Observed versus predicted hospital mortality in general wards patients assisted by a medical emergency team. Signa Vitae. 2012. 7(1);38-42.
1. Joynt GM, Gomersall CD, Tan P, Lee A, et al. Prospective evaluation of patients refused admission to an intensive care unit: triage, futility and outcome. Intensive Care Med 2001;27:1459-65.
2. Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, et al. Survival of critically ill patients hospitalized in and out of intensive care unit beds. Crit Care Med 2004; 32:1654-61.
3. Mnatzaganian G, Sprung CL, Zitser-Gurevich Y, Galai N, et al. Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit. Crit Care Med 2008;36:1097-04.
4. American College of Critical Care Medicine of the Society of Critical care Medicine: Guidelines for ICU admission, discharge and triage. Crit Care Med 1999;27:633-8.
5. Savoia G, Bosco G, Cerchiari E, De Blasio E, et al. for SIAARTI – IRC Working Group: SIAARTI–IRC: Recommendations for organizing responses to in-hospital emergencies. Minerva Anestesiol 2007;73:533-53.
6. Strauss MJ, LoGerefo JP, Yeltatzie JA, Temkin N, et al: Rationing of intensive care unit services. An everyday occurrence. JAMA 1986;255:1143-6.
7. Singer DE, Carr PL, Mulley AG, Thibault GE. Rationing intensive care-physician responses to a resource shortage. N Engl J Med 1983;309:1155-60.
8. Metcalfe MA, Slogget A, McPherson K. Mortality among appropriately referred patients refused admission to intensive-care units. Lancet 1997;350:7-11.
9. Hersch M, Sonnenblick M, Vanhecke T, Gandhi M, McCullough PA, Lazar MH, et al. Outcomes of patients refused considered for, but not admitted to, the intensive care unit. Crit Care Med 2008;36:812-7.
10. DeVita M, Bellomo R, Hillman K, Kellum J, et al. Findings of the First Consensus Conference on Medical Emergency Teams. Crit Care Med 2006;34:2463-78.
11. Winters BD, Cuong Pam J, Hunt EA, Guallar E, et al.. Rapid response systems. A systematic review. Crit Care Med 2007;35:1238-43.
12. DeVita MA, Bellomo R. The case of rapid response systems: Are randomized clinical trials the right methodology to evaluate systems of care? Crit Care Med 2007;35:1413-4.
13. Le Galle JR, Lemeshow S , Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA1993; ?: 22-9.
14. Cabrini L, Idone C, Colombo S et al. Medical Emergency Team and non-invasive ventilation outside ICU for acute respiratory failure. Inten-sive Care Med 2009;35:333-43.
15. Duke G, Green J, Briedis J. Survival of critically ill medical patients is time-critical. Crit Care Resusc 2004;6:261-7.
16. Mitchell IA, McKay H, Van Leuvan C et al. A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients. Resuscitation 2010;81:658-66.
17. Tee A, Calzavacca P, Licari E, Goldsmith D, et al. Bench-to-bedside review: the MET syndrome - the challenges of researching and adopting medical emergency teams. Crit Care 2008;12:205doi:10.1186/cc6199.
18. Calzavacca P, Licari E, Tee A et al. Features and outcome of patients receiving multiple Medical Emergency team reviews. Resuscitation 2010;81:1509-15.
19. Cabrini L, Antonelli M, Savoia G, Landriscina M. Non-invasive ventilation outside of the Intensive Care Unit: an Italian survey. Minerva Anestesiol. 2011;77:313-22..
20. Flabouris A, Chen J, Hillman K et al. Timing and interventions of emergency teams during the MERIT study. Resuscitation 2010;81:25-30.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.