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, 14 (11), e0225229

Performance of Patient Acuity Rating by Rapid Response Team Nurses for Predicting Short-Term Prognosis


Performance of Patient Acuity Rating by Rapid Response Team Nurses for Predicting Short-Term Prognosis

Hyung-Jun Kim et al. PLoS One.


Background: Although scoring and machine learning methods have been developed to predict patient deterioration, bedside assessment by nurses should not be overlooked. This study aimed to evaluate the performance of subjective bedside assessment of the patient by the rapid response team (RRT) nurses in predicting short-term patient deterioration.

Methods: Patients noticed by RRT nurses based on the vital sign instability, abnormal laboratory results, and direct contact via phone between November 1, 2016, and December 12, 2017, were included. Five RRT nurses visited the patients according to their shifts and assessed the possibility of patient deterioration. Patient acuity rating (PAR), a scale of 1-7, was used as the tool of bedside assessment. Other scores, including the modified early warning score, VitalPAC early warning score, standardised early warning score, and cardiac arrest risk triage, were calculated afterwards. The performance of these scores in predicting mortality and/or intensive care unit admission within 1 day was compared by calculating the area under the receiver operating curve.

Results: A total of 1,426 patients were included in the study, of which 258 (18.1%) died or were admitted to the intensive care unit within 1 day. The area under the receiver operating curve of PAR was 0.87 (95% confidence interval [CI] 0.84-0.89), which was higher than those of modified early warning score (0.66, 95% CI 0.62-0.70), VitalPAC early warning score (0.69, 95% CI 0.66-0.73), standardised early warning score (0.67, 95% CI 0.63-0.70) and cardiac arrest risk triage (0.63, 95% CI 0.59-0.66) (P<0.001).

Conclusions: PAR assessed by RRT nurses can be a useful tool for assessing short-term patient prognosis in the RRT setting.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. Receiver operating characteristic curve of each score.
Patient Acuity Rating assessed by the rapid response team nurse was superior in predicting mortality and/or intensive care unit admission within the next day, compared to several other early warning scores.
Fig 2
Fig 2. Calibration plot of Patient Acuity Rating for predicting the probability of the composite outcome.

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Grant support

The corresponding author (YJL) was supported by the SNUBH Research Fund (grant no 02-2018-051). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.