Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan

<i>Background and Objectives</i>: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of int...

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Autores principales:	Reiko Okawa, Tomoe Yokono, Yu Koyama, Mieko Uchiyama, Naoko Oono
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	rapid response system rapid response team respiratory rates inspired oxygen Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/cdb6b44e846c41cd9d39b7f6aad31e8c
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spelling	oai:doaj.org-article:cdb6b44e846c41cd9d39b7f6aad31e8c2021-11-25T18:18:29ZClinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan10.3390/medicina571111941648-91441010-660Xhttps://doaj.org/article/cdb6b44e846c41cd9d39b7f6aad31e8c2021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1194https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objectives</i>: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. <i>Materials and Methods</i>: We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO<sub>2</sub>) and the fraction of inspired oxygen (FiO<sub>2</sub>) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO<sub>2</sub> that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. <i>Results</i>: We analyzed the data of 65 patients who met our hospital’s RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) (<i>p</i> < 0.01) and the needed FiO<sub>2</sub> were significantly increased (<i>p</i> < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO<sub>2</sub> cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO<sub>2</sub> ≥ 30%. <i>Conclusions</i>: The combined use of RR ≥ 26 breaths/min and needed FiO<sub>2</sub> ≥ 30% might be valid for identifying patients requiring intensive care management.Reiko OkawaTomoe YokonoYu KoyamaMieko UchiyamaNaoko OonoMDPI AGarticlerapid response systemrapid response teamrespiratory ratesinspired oxygenMedicine (General)R5-920ENMedicina, Vol 57, Iss 1194, p 1194 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	rapid response system rapid response team respiratory rates inspired oxygen Medicine (General) R5-920
spellingShingle	rapid response system rapid response team respiratory rates inspired oxygen Medicine (General) R5-920 Reiko Okawa Tomoe Yokono Yu Koyama Mieko Uchiyama Naoko Oono Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
description	<i>Background and Objectives</i>: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. <i>Materials and Methods</i>: We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO<sub>2</sub>) and the fraction of inspired oxygen (FiO<sub>2</sub>) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO<sub>2</sub> that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. <i>Results</i>: We analyzed the data of 65 patients who met our hospital’s RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) (<i>p</i> < 0.01) and the needed FiO<sub>2</sub> were significantly increased (<i>p</i> < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO<sub>2</sub> cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO<sub>2</sub> ≥ 30%. <i>Conclusions</i>: The combined use of RR ≥ 26 breaths/min and needed FiO<sub>2</sub> ≥ 30% might be valid for identifying patients requiring intensive care management.
format	article
author	Reiko Okawa Tomoe Yokono Yu Koyama Mieko Uchiyama Naoko Oono
author_facet	Reiko Okawa Tomoe Yokono Yu Koyama Mieko Uchiyama Naoko Oono
author_sort	Reiko Okawa
title	Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
title_short	Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
title_full	Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
title_fullStr	Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
title_full_unstemmed	Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan
title_sort	clinical sign-based rapid response team call criteria for identifying patients requiring intensive care management in japan
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/cdb6b44e846c41cd9d39b7f6aad31e8c
work_keys_str_mv	AT reikookawa clinicalsignbasedrapidresponseteamcallcriteriaforidentifyingpatientsrequiringintensivecaremanagementinjapan AT tomoeyokono clinicalsignbasedrapidresponseteamcallcriteriaforidentifyingpatientsrequiringintensivecaremanagementinjapan AT yukoyama clinicalsignbasedrapidresponseteamcallcriteriaforidentifyingpatientsrequiringintensivecaremanagementinjapan AT miekouchiyama clinicalsignbasedrapidresponseteamcallcriteriaforidentifyingpatientsrequiringintensivecaremanagementinjapan AT naokooono clinicalsignbasedrapidresponseteamcallcriteriaforidentifyingpatientsrequiringintensivecaremanagementinjapan
_version_	1718411406133428224

Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan

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