Application of Cardiac Arrest Risk Triage (CART) Score for In-Hospital Cardiac Arrest Prediction in Emergency Department, Rajavithi Hospital
Category:
Background:
Acute deterioration of critically ill patients are often preceded by worsen of physiologic parameters , i.e. vital signs. Many studies showed the evidence that early recognition of these parameters can help identify the serious adverse events (SAEs), such as cardiac arrest during hospital stay, and may lead to prevention of these medical emergencies. Most of previous published studies , modified early warning score (MEWS) and Cardiac arrest risk triage (CART) , were derived from in-patients ward data. In this study , we would like to determine their utilities of predict cardiac arrest and serious adverse events(SAEs) in the critically ill patients in the setting of emergency department , Rajavithi hospital
Objective:
to evaluate the Cardiac Arrest Risk Triage (CART) score for predicting in-hospital cardiac arrest both during in emergency department and during hospital admission
Method:
the total 146 patients who were triaged into emergency categories (ESI1-2 or 3-tiered emergent categories) were enrolled in the study. The patients with cardiac arrest event in any time ( include both arrest event in emergency room or at ward) were defined as case group, n=54, which data derived from Rajavithi emergency department cardiac arrest registry from may 2006 to november 2015. The patients who did not have cardiac arrest events were defined as control group , n=92, which data period were January 2015 to november 2015. The CART score was calculated at 16 hours(CART16), 12 hours(CART12), 8 hours (CART8), 4 hours (CART4), 1 hour (CART1) and 30min (CART0.5) prior to cardiac arrest event
Results:
54 patients with cardiac arrest events and 92 patient without arrest events. In cardiac arrest group, 51.9% are male with age mean 63.83±19.93 years. In control groups, 58.7% are male with age mean 59.71±16.93 years. Most common affected organ system are respiratory system in both group(40.7% vs 45.7% respectively). In-hospital mortality were related to the increasing in CART score at 12 hours(p=0.26), 8 hour(p<0.01), 4 hour(p<0.01), 1 hour and 30 minutes preceded to the cardiac arrest events(p<0.01), especially CART score at 8,4,1 hour and 30 minutesationship to arrest event within 72 hours after hospital arrival.(p<0.01) The score of the patients who have Cardiac arrest and do not have Cardiac arrest that receive treatment in ICU did not reveal any difference in each period of time. CART score over 16.5 has significant relationship to arrest events with sensitivity 54.2% and specificity 54.1%
Conclusion:
increasing CART score had shown the relationship to in-hospital cardiac arrest events and could be used in the setting of critically ill emergency patients. Therefore, further prospective study would be suggested to validate its application to emergency department setting.