Abstract 138: Early Warning Signs Predict Survival From Met Calls in Surgical Patients
Introduction: MET calls are designed to treat patients early enough to prevent significant morbidity and mortality. Identification of patients at an even earlier phase may further improve outcomes. We sought to describe antecedents to MET calls in surgical patients at the Royal Melbourne Hospital (RMH).
Methods: Retrospective chart review of MET calls in surgical patients at RMH from January to March 2009. The first MET call for each patient was analyzed for antecedents and outcomes. The primary outcome was survival to hospital discharge.
Results: From January to March 2009, 49 surgical patients at RMH received 65 MET calls. The patients were aged 60 years (range 17–97), and 59% were male. Twelve patients (24.5%) died during their hospital stay after the MET call. Patients were more likely to die if they were older than 80 years (OR 5.9, 95%CI 1.44–24.29, p<0.01), or were “Neurosurgical” (OR 5.9, 1.25–27.69, p=0.02). Early signs (ES) were common in the 24 hours prior to the MET call, especially SpO2 90–95% (in 59.2%), “alteration in mentation” (38.8%), systolic BP 90–100 mmHg (32.7%), and “new pain” (24.5%). Ten of the twelve patients who died during admission (83%) had an “alteration in mentation” in the 24 hours preceding their MET call. There was an increased likelihood of death if patients had the following ES: ‘alteration in mentation’ (OR 15.56, 2.86–84.62, p<0.001), ‘GCS 9–11 or alteration in GCS>2’ (OR 8.75, 1.36–56.38, p= 0.03), ‘Pulse rate 40–49 or 131–140/min’ (OR 5.89, 1.25–27.69, p=0.03). “MET breaches” (no call activated) occurred in 18/49 patients (37%) in the previous 8 hours (5/18 [28%] died), and 20/49 (41%) in the previous 24 hours (7/20 [35%] died). All patients with a Not For Resuscitation order in place died in hospital after the MET call.
Conclusions: The hospital mortality from MET calls in surgical patients was 24.5%, and mortality was higher in: patients older than 80, neurosurgical patients, and patients who had previously demonstrated a number of “Early signs” (ie. neurological state and heart rate). MET “breaches” were common. Earlier signs and risk factors should be used to triage surgical patients, and to facilitate escalation of care.
- © 2010 by American Heart Association, Inc.