An intelligent score based system

The Hospital, by definition a structure for the diagnosis and treatment of admitted acute patients, may paradoxically fail in its overall management of critical events ranging from sudden deterioration, more or less rapid, of general conditions to cardiac arrest. The situation is often manifested by late intervention, be it resuscitation of a patient in their bed, in surgery or in the intensive care unit.

Intrahospital mortality is currently regarded as a comprehensive indicator of the quality of care provided to patients (Joint Commission for Hospital Accreditation). Within hospitals the mortality rate from sudden cardiac arrests, although the extensive and unambiguous epidemiological data is not available, remains high. The incidents, based on the data of international literature, is between 1-5% admissions/year or 0.175 beds/year (Hodgetts, Resuscitation 2002 - Peberdy, Resuscitation 2003).

Much of the literature highlights that the prognosis of the intrahospital cardiac arrests, despite all the organisational efforts aimed at implementing an optimal response model, is still too often unfavourable; the survival rate for hospital discharge, worldwide, was about 14 – 18% for many years.

The cardiac arrest, whilst representing the final stage of the most morbid events, must not be regarded as inevitable: the intrahospital cardiac arrest that occurs with normal hospitalised patients is not a sudden cardiac death in the majority of cases. Preceding this, in 75 – 80% of the cases there are abnormal physiological parameters and it is therefore potentially avoidable; the signs of clinical deterioration that evolve rapidly relating the cardiac arrest are present at least eight hours before the cardiac arrest and it is therefore essential to recognise them immediately.

It is for this reason that the international literature available on the subject and the most recent worldwide guidelines for cardiopulmonary resuscitation are aimed at the prevention of the cardiac arrest by recognising the signs and symptoms that precede this extreme situation and the appropriate treatment.

At a recent international Consensus Conference, that was attended by experts from around the world and published in Critical Care Medicine in October 2006, it reviewed the most common organisational models developed in different countries and different locations (Australia, North America and Europe). The various intrahospital emergency response modes were examined with the aim of preventing cardiac arrests by rapid recognition of the clinical deterioration that characterises the critical patient and the rapid alert of the experts that provide the answers.