Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department*

Abstract

MET scores collected early after admission or throughout the stay in the emergency department allow for simple identification of patients at risk of unfavorable outcome during the subsequent intensive care unit stay.

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

“…Research evidence supporting EWS validity and reliability showed that physiological variables (HR, BP, RR) accurately predicted outcomes which were associated with an increased risk of unplanned ICU admission/ readmission and mortality in adult and paediatric patients within 24-48 hours (Etter et al 2008, Cei et al 2009Cuthbertson et al 2010, Massey et al 2015. The risk of mortality was associated with an increased number of abnormal observations (Trinkle & Flabouris 2011, Visser 2014) and a higher EWS score (Mandell et al 2015).…”

Emergency department rapid response systems

“…These findings lend further weight to the need for an ED-specific system to identify deteriorating patients. However, the major issue with this study is that the patients had already deteriorated to the point of requiring ICU admission from the ED [70]. However, the major issue with this study is that the patients had already deteriorated to the point of requiring ICU admission from the ED [70].…”

Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department

“…The concept of adding up the VSS criteria applied in this study is analogous to the use of the sum of failing organs for the calculation of organ dysfunction scores in intensive care [37-39] and we previously used a similar approach for patients admitted to intensive care from the emergency department [24]. …”

“…The original MET calling criteria contain the criterion "concern", which was not included in the VSS. "Concern" represents a subjective rating rather than a measurable parameter and was shown to have a low frequency and lack of predictive value in one retrospective study in emergency patients [24]. To evaluate associations between VSS scores and predefined outcome variables, the following definitions were used: VSS initial denotes the VSS score in the first 15 minutes after admission to the emergency department and VSS max denotes the maximum VSS score throughout the total stay in the emergency department.…”

“…Systematic checks for airway, breathing, circulation and level of consciousness are included in resuscitation and trauma guidelines [10,11], and for assessment of risk of deterioration of ward patients in medical emergency team (MET) systems [12-23]. We found in a recent retrospective study that the MET calling criteria were highly predictive of hospital outcome in patients admitted to intensive care from the emergency department [24]. Most emergency departments, including ours, do not systematically screen all patients [25].…”