Chest
Original ResearchCritical CarePredicting Cardiac Arrest on the Wards: A Nested Case-Control Study
Section snippets
Study Setting and Population
We conducted a retrospective nested case-control study at an academic, tertiary care hospital with approximately 500 inpatient beds grouped by clinical service. Our hospital has had an RRT in place since 2008 that is led by a critical care nurse and respiratory therapist with consultation from a hospitalist physician and/or pharmacist upon request. The RRT activation criteria include “tachypnea,” “tachycardia,” “hypotension,” and “staff worry,” but specific vital sign thresholds are not stated.
Patient Characteristics
During the study period there were 55,121 hospital admissions, 436 index CAs (7.9 arrests per 1,000 admissions), and 462 RRT calls (8.4 calls per 1,000 admissions).
Eighty-nine patients experienced a CA on the ward during the study period. One patient had no ward vital signs prior to CA and was excluded. Eighty-eight case patients were matched to 352 control subjects. Patient demographic data are shown in Table 1. Seventy-three percent of admissions were medical, and 27% were surgical. Case
Discussion
In this longitudinal nested case-control study, we demonstrated that patients who experience a CA on the ward have vital signs that are similar to other patients on admission but significantly different in the 48 h prior to the event. The most accurate individual predictors of CA were maximum respiratory rate, heart rate, pulse pressure index, and minimum diastolic BP. Our results have significant implications for the detection arm of the RRT because most activation criteria use poor predictors
Acknowledgments
Author contributions: Drs Churpek and Edelson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Churpek: contributed to the design of the study, data analysis, and manuscript preparation.
Mr Yuen: contributed to data collection and revisions to the manuscript.
Mr Huber: contributed to design of the study, data collection, and revisions to the manuscript.
Dr Park: contributed to data analysis and revisions
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Funding/Support: Dr Edelson is supported by a career development award from the National Heart, Lung, and Blood Institute [K23HL097157-01]. Dr Churpek is supported by a National Institutes of Health grant [T32HL07605].
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