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Derivation of a cardiac arrest prediction model using ward vital signs*

Churpek, Matthew M. MD, MPH; Yuen, Trevor C. BA; Park, Seo Young PhD; Meltzer, David O. MD, PhD; Hall, Jesse B. MD; Edelson, Dana P. MD, MS

doi: 10.1097/CCM.0b013e318250aa5a
Clinical Investigations

Objective: Rapid response team activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage score to predict cardiac arrest and compared it to the Modified Early Warning Score, a commonly cited rapid response team activation criterion.

Design: A retrospective cohort study.

Setting: An academic medical center in the United States.

Patients: All patients hospitalized from November 2008 to January 2011 who had documented ward vital signs were included in the study. These patients were divided into three cohorts: patients who suffered a cardiac arrest on the wards, patients who had a ward to intensive care unit transfer, and patients who had neither of these outcomes (controls).

Interventions: None.

Measurements and Main Results: Ward vital signs from admission until discharge, intensive care unit transfer, or ward cardiac arrest were extracted from the medical record. Multivariate logistic regression was used to predict cardiac arrest, and the cardiac arrest risk triage score was calculated using the regression coefficients. The model was validated by comparing its accuracy for detecting intensive care unit transfer to the Modified Early Warning Score. Each patient’s maximum score prior to cardiac arrest, intensive care unit transfer, or discharge was used to compare the areas under the receiver operating characteristic curves between the two models. Eighty-eight cardiac arrest patients, 2,820 intensive care unit transfers, and 44,519 controls were included in the study. The cardiac arrest risk triage score more accurately predicted cardiac arrest than the Modified Early Warning Score (area under the receiver operating characteristic curve 0.84 vs. 0.76; p = .001). At a specificity of 89.9%, the cardiac arrest risk triage score had a sensitivity of 53.4% compared to 47.7% for the Modified Early Warning Score. The cardiac arrest risk triage score also predicted intensive care unit transfer better than the Modified Early Warning Score (area under the receiver operating characteristic curve 0.71 vs. 0.67; p < .001).

Conclusions: The cardiac arrest risk triage score is simpler and more accurately detected cardiac arrest and intensive care unit transfer than the Modified Early Warning Score. Implementation of this tool may decrease rapid response team resource utilization and provide a better opportunity to improve patient outcomes than the modified early warning score.

From the Section of Pulmonary and Critical Care (MMC, JBH); Section of Hospital Medicine (TCY, DOM, DPE); and Department of Health Studies (SYP), University of Chicago, Chicago, IL.

*See also p. 2243.

Dr. Churpek is supported by a National Institute of Health grant (T32 HL 07605). Dr. Hall has received royalties from McGraw-Hill and honoraria from the American Thoracic Society and the American College of Chest Physicians. Dr. Meltzer acknowledges support from the Agency for Healthcare Quality and Research through the Hospital Medicine and Economics Center for Education and Research in Therapeutics (U18 HS016967-01, Meltzer, PI), and from the National Institute of Aging through a Midcareer Career Development Award (1 K24 AG031326-01, PI Meltzer). Dr. Edelson is supported by a career development award from the National Heart, Lung, and Blood Institute (K23 HL097157-01); has received research support, speaking honoraria and consulting fees from Philips Healthcare (Andover, MA); and is on the advisory board of Sotera Wireless (San Diego, CA). The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: dperes@uchicago.edu

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins