Introduction
Background
Importance
Goals
Methods
Study design and setting
Subjects
Ethical approval
Data extraction
Outcomes
Airway interventions |
• Use of airway adjunct or procedure to maintain patent airway. |
• Use of intravenous/intramuscular adrenaline to treat or prevent airway compromise. |
Breathing interventions |
• Bag-valve-mask ventilation (unless during procedural sedation), intermittent positive pressure ventilation, or non-invasive ventilation. |
• Decompression of tension pneumothorax. |
• Drainage of significant pleural effusion (>1 litre). |
• Insertion of chest drain for pneumothorax in patients with pre-existing lung disease. |
• Intravenous therapy except steroids for asthma. |
Circulation interventions |
• Cardioversion (chemical or DC) of ventricular tachycardia or supraventricular tachycardia or atrial fibrillation with accessory pathway. |
• CPR. |
• Emergency endoscopy or surgery for upper GI bleed or use of Sengstaken tube or use of vasopressin/terlipressin. |
• Infusion of >2 litres of fluid or transfusion for haemodynamic instability. |
• Laparotomy for GI bleed/gynaecological bleed (including ectopic)/AAA. |
• Sepsis care bundle. |
• Thrombolysis for AMI or PE, or percutaneous revascularisation. |
• Therapeutic (not diagnostic) pericardiocentesis. |
• Transcutaneous or external pacing or administration of atropine (except in theatre). |
• Vasopressor use (except bolus dosing in theatre). |
Disability interventions |
• Administration of naloxone or flumazenil (unless related to procedural sedation). |
• Administration of 10 %/50 % dextrose. |
• Administration of >1 dose benzodiazepines/other anticonvulsants for fitting. |
• Neurosurgical intervention. |
Other interventions |
• Active rewarming (not including Bearhugger). |
• Laparotomy for sepsis/infarction/obstruction. |
• New initiation of renal replacement therapy. |
• Specific poisons antidotes including N-acetylcysteine. |
Data analysis
Results
Study subjects
Derivation cohort | Validation cohort | |||
---|---|---|---|---|
Full cohort for death (n = 2437) | Subset for potential to benefit (n = 398) | Full cohort for death (n = 2322) | Subset for potential to benefit (n = 227) | |
Variable | Mean (sd; range) | |||
Age | 69 (19; 18–103) | 66.5 (20.2; 18–102) | 70 (19; 18–103) | 71.3 (18.3; 19–96) |
Respiratory rate | 19 (6;6–60) | 20 (7; 6–45) | 20 (6.6; 8–80) | 20 (5.8; 12–40) |
Systolic BP | 136 (29; 24–266) | 133 (29; 45–243) | 139 (28.4; 44–261) | 138 (28.6; 60–249) |
Diastolic BP | 75 (15; 30–153) | 75 (15; 36–130) | 76 (15; 11–151) | 74 (15; 36–142) |
Pulse rate | 88 (24; 21–215) | 92 (24; 35–188) | 88 (23; 20–180) | 89 (21.9; 35–152) |
Temperature | 36.6 (1.2; 26.0–41.0) | 36.5 (1.2; 26.0–40.0) | 36.5 (1.1; 25.2–40.5) | 36.6 (1.40; 26.4–39.6) |
Variable | Median (IQR; range) | |||
SaO2 breathing air | 97 (95–98; 50–100) | 97 (94–98; 66–100) | 97 (95–98; 45–100) | 96 (94–98; 45–100) |
SaO2 breathing oxygen | 98 (95–100; 24–100) | 97 (96–99; 71–100) | 98 (95–100; 60–100) | 98 (96–100; 84–100) |
GCS | 15 (15–15; 3–15) | 15 (15–15; 3–15) | 15 (15–15; 3–15) | 15 (15–15; 7–15) |
Variable | Number (percentage) | |||
Male | 1131 (46.4) | 183 (46) | 1093 (46.5) | 95 (42) |
Active malignancy | 110 (4.5) | 23 (5.8) | 96 (4.1) | 6 (2.7) |
Outcomes | Number (percentage) | |||
All deaths | 128 (5.2) | 141 (6.0) | ||
Inevitable death | 15 (3.7) | 2 (0.8) | ||
Potentially preventable death | 5 (1.2) | 1 (0.4) | ||
Prevented death | 79 (19.8) | 35 (15.4) |
Statistical analysis
Variable | exp(B) |
P
| 95 % CI for exp(B) | |
---|---|---|---|---|
Pulse (ref <71) | <0.001 | |||
71–110 | 0.522 | 0.316 | 0.862 | |
>110 | 3.756 | 1.930 | 7.309 | |
Respiratory rate (ref <16) | <0.001 | |||
16–18 | 1.009 | 0.605 | 1.683 | |
19–23 | 3.463 | 1.819 | 6.594 | |
>23 | 3.991 | 2.140 | 7.443 | |
Systolic BP (ref 121–180) | <0.001 | |||
<100 | 4.461 | 2.397 | 8.302 | |
100–120 | 2.140 | 1.250 | 3.665 | |
>180 | 31.475 | 13.479 | 73.496 | |
Pulse pressure (ref 51–76) | <0.001 | |||
<51 | 1.791 | 1.143 | 2.805 | |
>76 | 3.540 | 2.030 | 6.174 | |
GCS (ref 13–15) | <0.001 | |||
3–8 | 34.446 | 16.607 | 71.447 | |
9–12 | 2.203 | 1.235 | 3.930 | |
SaO2 (ref low risk (99–100 breathing air)) | <0.001 | |||
High (<95 breathing air or <96 with supplemental O2) | 1.583 | 0.156 | 0.839 | 2.987 |
Moderate (95–98 breathing air or >95 with supplemental O2) | 0.470 | 0.004 | 0.283 | 0.781 |
Variable | exp(B) |
p
| 95 % CI for exp(B) | |
---|---|---|---|---|
Pulse (ref <71) | 0.02 | |||
71–110 | 0.371 | 0.034 | 4.101 | |
>110 | 5.176 | 1.125 | 23.816 | |
Respiratory rate (ref <16) | 0.228 | |||
16–18 | 4.814 | 0.636 | 36.443 | |
19–23 | 19.144 | 1.035 | 354.172 | |
>23 | 6.664 | 0.723 | 61.405 | |
Systolic BP (ref 121–180) | 0.061 | |||
<100 | 3.687 | 1.089 | 12.481 | |
100–120 | 1.112 | 0.407 | 3.043 | |
>180 | 2.468 | 0.615 | 9.905 | |
Pulse pressure (ref 51–76) | 0.536 | |||
<51 | 1.479 | 0.548 | 3.992 | |
>76 | 1.729 | 0.611 | 4.894 | |
GCS (ref 13–15) | <0.001 | |||
3–8 | 23.013 | 3.806 | 139.163 | |
9–12 | 4.060 | 1.114 | 14.790 | |
SaO2 (ref low risk) | 0.971 | |||
High | 0.946 | 0.146 | 6.123 | |
Moderate | 0.840 | 0.164 | 4.300 | |
Pulse/SaO2 interaction | 0.210 | |||
Respiratory rate/SaO2 interaction | 0.210 |