title: Combinations of early signs of critical illness predict in-hospital death-the SOCCER study (signs of critical conditions and emergency responses).
abstract: BACKGROUND
  Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with late signs (LS) with in-hospital death.
  
  
  METHODS
  A cross-sectional survey was undertaken of 3046 non-do not attempt resuscitation adult admissions in 5 hospitals without MET over 14 days. The medical records were reviewed for recordings of 26 ES and 21 LS and in-hospital death. Combinations of ES with or without LS were examined as predictors of death. Global modified early warning scores (GMEWS) were calculated.
  
  
  RESULTS
  ES with LS, plus LS only, had higher odd ratios than ES alone. Four combinations of ES were strongly associated with death: cardiovascular plus respiratory with decrease in urinary output, cardiovascular plus respiratory with a decrease in consciousness, respiratory with decrease in urinary output, and cardiovascular plus respiratory. In other combinations, recordings of SpO2 90-95%, systolic blood pressure 80-100 mmHg or decrease in urinary output in turn occurring with one or more disturbed blood gas variable were associated with death. Compared with admissions whose GMEWS were 0-2, admissions with GMEWS 5-15 were 27.1 times more likely to die while those with GMEWS 3-4 were 6.5 times more likely.
  
  
  CONCLUSIONS
  The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria.
authors.affiliation: Discipline of Anaesthetics, Intensive Care and Emergency Medicine, University of NSW, Sydney, Australia. dharrison@stvincents.com.au
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Harrison
authors.forename: Theresa
authors.initials: T
authors.lastname: Jacques
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kilborn
mesh_terms: D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality*; D019091:Critical Pathways / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data; D009517:New South Wales; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors