title: Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital.
abstract: OBJECTIVE
  To make a preliminary estimation of the workload for a medical emergency team (MET) in a Scandinavian University Hospital by recording prevalent physiological data on all adult patients and to see if the patients with deviating physiology (i.e. fulfilling the study criteria, in essence a set of simplified MET-criteria) had an elevated mortality. We also tested sensitivity and specificity by altering the cut-off levels of the calling criteria.
  
  
  METHODS
  Cross sectional prevalence study.
  
  
  METHODS
  University hospital in the capital of Sweden.
  
  
  METHODS
  Adult patients treated in the general wards of the hospital. Patients from psychiatric wards and intensive care units were excluded from the study.
  
  
  METHODS
  None.
  
  
  RESULTS
  4.5% of the scored patients fulfilled the study criteria. These patients had a 30-day mortality of 25% (confidence interval 12.7-41.2) as compared to 3.5% (2.4-5) for the patients not fulfilling the study criteria. Extended criteria revealed 18 deaths within 30 days, 8 more deaths than the original study criteria. However, 123 patients - equalling 13.8% of the cohort (CI 11.6-16.2) - fulfilled these criteria as compared to the 40 patients fulfilling the original study criteria. Thus, the 30-day mortality of the patients with positive extended criteria totalled 14.6% (CI 8.9-22.1). Restricted criteria showed a mere 20 patients (2.2%; CI 1.4-3.5) and only 4 deaths, making 30-day mortality 20% (CI 5.7-43.7); thus, sensitivity was actually lower using restricted criteria.
  
  
  CONCLUSIONS
  Even these modified - and simplified - MET-criteria proved to be able to single out patients with elevated mortality as compared to the rest of the hospital population. Extending the criteria significantly lowered sensitivity and would extend the MET-workload enormously. Restricting the criteria led to missed mortalities where intervention could be beneficial. The results suggest that a routine use of simple physiological tests can be of help in the identification of patients at risk.
authors.affiliation: Department of Anesthesiology and Intensive Care, Karolinska University Hospital Solna, S-171 76 Stockholm, Sweden.
authors.forename: Max B
authors.initials: MB
authors.lastname: Bell
authors.forename: David
authors.initials: D
authors.lastname: Konrad
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Claes-Roland
authors.initials: CR
authors.lastname: Martling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010348:Patient Care Team / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D013548:Sweden; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*