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Original Research: CRITICAL CARE |

Predicting Cardiac Arrest on the WardsIn-hospital Cardiac Arrest Prediction: A Nested Case-Control Study

Matthew M. Churpek, MD, MPH; Trevor C. Yuen, BA; Michael T. Huber, BA; Seo Young Park, PhD; Jesse B. Hall, MD, FCCP; Dana P. Edelson, MD
Author and Funding Information

From the Section of Pulmonary and Critical Care (Drs Churpek and Hall), Section of Hospital Medicine (Mr Yuen and Dr Edelson), Pritzker School of Medicine (Mr Huber), and Department of Health Studies (Dr Park), University of Chicago, Chicago, IL.

Correspondence to: Dana Edelson, MD, Section of Hospital Medicine, University of Chicago, 5841 S Maryland Ave, MC 5000, Chicago, IL 60637; e-mail: dperes@uchicago.edu


Funding/Support: Dr Edelson is supported by a career development award from the National Heart, Lung, and Blood Institute [K23HL097157-01]. Dr Churpek is supported by a National Institutes of Health grant [T32HL07605].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1170-1176. doi:10.1378/chest.11-1301
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Background:  Current rapid response team activation criteria were not statistically derived using ward vital signs, and the best vital sign predictors of cardiac arrest (CA) have not been determined. In addition, it is unknown when vital signs begin to accurately detect this event prior to CA.

Methods:  We conducted a nested case-control study of 88 patients experiencing CA on the wards of a university hospital between November 2008 and January 2011, matched 1:4 to 352 control subjects residing on the same ward at the same time as the case CA. Vital signs and Modified Early Warning Scores (MEWS) were compared on admission and during the 48 h preceding CA.

Results:  Case patients were older (64 ± 16 years vs 58 ± 18 years; P = .002) and more likely to have had a prior ICU admission than control subjects (41% vs 24%; P = .001), but had similar admission MEWS (2.2 ± 1.3 vs 2.0 ± 1.3; P = .28). In the 48 h preceding CA, maximum MEWS was the best predictor (area under the receiver operating characteristic curve [AUC] 0.77; 95% CI, 0.71-0.82), followed by maximum respiratory rate (AUC 0.72; 95% CI, 0.65-0.78), maximum heart rate (AUC 0.68; 95% CI, 0.61-0.74), maximum pulse pressure index (AUC 0.61; 95% CI, 0.54-0.68), and minimum diastolic BP (AUC 0.60; 95% CI, 0.53-0.67). By 48 h prior to CA, the MEWS was higher in cases (P = .005), with increasing disparity leading up to the event.

Conclusions:  The MEWS was significantly different between patients experiencing CA and control patients by 48 h prior to the event, but includes poor predictors of CA such as temperature and omits significant predictors such as diastolic BP and pulse pressure index.

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