背景:临床判断,也被称为格式塔或直觉,可以预测恶化,并且可以轻松快速地获得。迄今为止,临床判断到底需要什么是未知的。这项研究的目的是阐明哪些特征定义了ED中医疗保健专业人员的临床印象。
方法:使用名义组技术(NGT)开发了一种基于共识的仪器来测量临床印象评分(CIS,量表1-10),并确定与更严重或更不严重的估计疾病严重程度相关的特征。这项单中心观察性队列研究包括517名就诊于ED的患者。仪器进行了前瞻性验证。.使用多元线性回归分析评估每个特征对临床印象的预测价值,以调整潜在的混杂因素,并在感染组中进行验证。
结果:ED的TheCIS与ICU入院相关(OR1.67[1.37-2.03],p<0.001),住院死亡率(OR2.25[1.33-3.81],p<0.001),和28天死亡率(OR1.33[1.07-1.65],<0.001)。干燥的粘膜,眼睛一瞥,体检时的红旗,动脉血气分析结果,心脏和呼吸频率,氧气模态,紧急分诊,年龄增长与较高的估计疾病严重程度(CIS)相关。另一方面,家庭行为,病人的自我评估,收缩压,Glascow昏迷量表与较低的估计疾病严重程度(CIS)相关。
结论:我们确定了一些与急诊医疗专业人员的临床印象相关的特征。将主观特征和客观测量结果转化为可量化的参数可能有助于开发一种新型的分诊工具,以识别有ED恶化风险的患者。
BACKGROUND: Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this
study was to elucidate which features define the clinical impression of health care professionals in the ED.
METHODS: A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1-10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort
study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group.
RESULTS: The CIS at the ED was associated with ICU admission (OR 1.67 [1.37-2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33-3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07-1.65], <0.001). Dry mucous membranes, eye glance, red flags during physical examination, results of arterial blood gas analysis, heart and respiratory rate, oxygen modality, triage urgency, and increased age were associated with a higher estimated disease severity (CIS). On the other hand, behavior of family, self-estimation of the patient, systolic blood pressure, and Glascow Coma Scale were associated with a lower estimated disease severity (CIS).
CONCLUSIONS: We identified several features that were associated with the clinical impression of health care professionals in the ED. Translating the subjective features and objective measurements into quantifiable parameters may aid the development of a novel triage tool to identify patients at risk of deterioration in the ED.