PDF(Pubmed)
Abstract：
BACKGROUND: Overcrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient\'s disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission.
METHODS: A prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients\' need for hospital admission.
RESULTS: In total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7-95.9% versus 60.6%, all p < 0.001).
CONCLUSIONS: Healthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.
METHODS: A prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients\' need for hospital admission.
RESULTS: In total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7-95.9% versus 60.6%, all p < 0.001).
CONCLUSIONS: Healthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.
摘要：
背景：急诊科（ED）的过度拥挤是一个全球性问题。早期和准确地识别患者的性格可能会限制在ED上花费的时间，从而提高所提供护理的吞吐量和质量。这项研究旨在比较医疗保健提供者和院前改良预警评分（MEWS）在预测住院需求方面的准确性。
方法：前瞻性，观察,我们进行了多中心研究,包括由救护车带到ED的成年患者.涉及紧急医疗服务（EMS）人员，要求ED护士和医生使用结构化问卷来预测入院的需求。主要终点是医疗服务提供者和院前MEWS预测患者入院需求的准确性之间的比较。
结果：共纳入798例患者，其中393例（49.2%）入院。预测住院的敏感性从80.0到91.9%不等。与EMS和ED护士相比，医生预测住院的准确性明显更高（p<0.001）。特异性范围为56.4至67.0%。所有医疗保健提供者在预测住院方面均优于MEWS≥3分（敏感性为80.0-91.9％对44.0％；所有p<0.001）。特别是对病房入院的预测比MEWS更准确(特异性94.7-95.9%对60.6%，所有p<0.001)。
结论：医疗保健提供者可以准确预测住院需求，并且所有提供者的表现都优于MEWS得分。
方法：前瞻性，观察,我们进行了多中心研究,包括由救护车带到ED的成年患者.涉及紧急医疗服务（EMS）人员，要求ED护士和医生使用结构化问卷来预测入院的需求。主要终点是医疗服务提供者和院前MEWS预测患者入院需求的准确性之间的比较。
结果：共纳入798例患者，其中393例（49.2%）入院。预测住院的敏感性从80.0到91.9%不等。与EMS和ED护士相比，医生预测住院的准确性明显更高（p<0.001）。特异性范围为56.4至67.0%。所有医疗保健提供者在预测住院方面均优于MEWS≥3分（敏感性为80.0-91.9％对44.0％；所有p<0.001）。特别是对病房入院的预测比MEWS更准确(特异性94.7-95.9%对60.6%，所有p<0.001)。
结论：医疗保健提供者可以准确预测住院需求，并且所有提供者的表现都优于MEWS得分。
