緊急聯絡資訊可以預測死亡風險
作者：Janis C. Kelly
出處：WebMD醫學新聞
October 20, 2009 — 日本研究者已經發展出一項使用來自緊急聯絡資訊的電腦流程，協助取得緊急應變車輛更快速地到達處於死亡風險病患所在地。
這個流程在確認那些危及生命風險高於10%的病患，敏感度超過80%。Kenji Ohshige醫師以及日本橫濱大學醫學院的研究者們描述這些於10月20日線上發表於開放點閱之BMC急診醫學期刊的新流程。
研究者們在6個月之間對超過6萬通緊急電話評估新檢傷分類系統的表現。緊急通話工作人員從電話中取得資料鍵入電腦為主的檢傷分類系統，這些數據包括病患的年齡、意識狀況、呼吸狀態、行走能力、是否發紺以及盜汗；病患是否躺著；以及致電者是否處於驚慌狀態。研究目的在於確定這個流程是否可以正確地確認出通話時風險高於10%的病患。
檢傷分類數據接著與病患實際的狀況進行比對：由救護車工作人員現場確認的死亡事件、到急診室後死亡、心跳以及/或是呼吸中止引起的危及生命狀態、嚴重但是並非危及生命狀態、中度或輕度狀態。
研究者們發現這個流程的敏感度有80.2%、專一度有96%，在預測哪些病患將會死亡或是發生心臟以及/或是呼吸中止上，有42%陽性預測值與99.2%陰性預測值。
Ohshige與其同事們的結論是，病患危急生命的風險可以定量地在緊急電話中評估，且有中等準確性。
這項新系統對於高風險病患，相較於其他病患，第一時間反應的救護人員的平均抵達時間可以提早一分鐘。研究人員將在未來的研究中，檢驗其對病患存活率的影響。
作者們表示，在日本，對於救護服務的需求在過去幾十年間快速增加，使得反應時間越來越長。他們寫到，隨著反應時間延長，減少突然心跳停止病患存活的數目，救護人員對於處於嚴重病況病患的優先度已成為日本到院前緊急醫療系統中的一個重點。
這項研究由橫濱大學安全處理局、日本科學促進會以及日本科學與技術署、科學與技術研究學會研究機構贊助。作者們表示已無相關資金上的往來。
Emergency Call Information Can Predict Death Risk
By Janis C. Kelly
Medscape Medical News
October 20, 2009 — Japanese researchers have developed a new computer algorithm that uses data from emergency calls to help get emergency response vehicles more quickly to those most at risk of dying.
The algorithm had higher than 80% sensitivity at identifying those with estimated life threat risk greater than 10% at the time of the call. Kenji Ohshige, MD, PhD, and researchers from the Yokohama City University School of Medicine in Japan describe the new algorithm in an article published online October 20 in the open-access journal BMC Emergency Medicine.
The researchers assessed the performance of the new triage system used in more than 60,000 emergency calls during a 6-month period. Emergency call workers entered data into a computer-based triage form during the telephone call. These data included the patient's age, consciousness, breathing status, walking ability, cyanosis, and sweating; whether the patient was lying down; and whether the caller was in a panic. The research objective was to determine whether the algorithm could accurately identify patients with a higher than 10% life threat risk at the time of the call.
The triage data were then compared with the patients' actual condition: death confirmed at the scene by ambulance crews, death in the emergency department, life-threatening condition with cardiac and/or pulmonary arrest, life-threatening condition without cardiac and/or pulmonary arrest, serious but not life-threatening condition, moderate condition, or mild condition.
The researchers found that the algorithm had 80.2% sensitivity, 96% specificity, 42% positive predictive value, and 99.2% negative predictive value for predicting which patients would die or had suffered cardiac and/or pulmonary arrest.
"A patient's life threat risk was quantitatively assessed at the moment of the emergency call with a moderate level of accuracy," Dr. Ohshige and colleagues conclude.
The new system also cut 1 minute from the mean arrival time of the first responder to the scene for highest-risk patients compared with response time for other patients. Effects on survival will be evaluated in future studies.
The authors note that demand for ambulance services in Japan has risen rapidly during the last decade, leading to longer response times. "As delayed response time reduces the number of patients who survive from sudden cardiac arrest, priority dispatch of ambulances to patients in a critical condition has become a matter of importance for the Japanese prehospital emergency medical services system," they write.
The study was supported by the Yokohama Safety Management Bureau, the Japan Society for the Promotion of Science, and the Research Institute of Science and Technology for Society, Japan Science and Technology Agency. The authors have disclosed no relevant financial relationships.
BMC Emerg Med. Published online October 20, 2009.
