Impact of a real-time critical care early warning platform on clinical outcomes in orthopedic trauma patients

doi:10.3877/cma.j.issn.2096-1537.2025.03.005

Abstract

Abstract:

Objective

To evaluate the impact of a real-time critical care early warning platform on outcomes in patients with orthopedic trauma.

Methods

A study enrolling patients admitted to the Orthopedic Department who were subsequently transferred to the Intensive Care Unit (ICU) at Zhongda Hospital, Southeast University between January 2020 and December 2023, was conducted. Non-trauma patients and whose with an ICU length of stay (LOS) of less than 24 hours were excluded. Patients monitored by the early warning platform were assigned to the alert group (68 cases), while those receiving standard care formed the non-alert group (121 cases). The primary endpoint was hospital LOS. Multivariate linear regression was used to assess the independent association between the platform use and hospital LOS.

Results

Among the 189 included patients, the median age was 72 years, 43.9% (83 cases) were female, 31.7% (60 cases) were emergency admissions, and 39.7% (75 cases) had spinal trauma. Baseline characteristics showed that, the proportion of patients with spinal trauma in the warning group (55.9%) was significantly higher than that in the non-alert group (30.6%), with a significant difference (χ²=10.612, P=0.001). Patients in the alert group had a significantly shorter median hospital LOS (P=0.006) and ICU LOS (P=0.017) compared to the non-alert group. Multivariate linear regression analysis confirmed that the application of the critical care early warning platform was independently associated with a reduction in hospital LOS (β=-5.91 days, SE=2.63, t=2.25, P=0.026).

Conclusion

The implementation of a real-time critical care early warning platform is associated with a significant reduction in hospital and ICU LOS among orthopedic trauma patients.

Key words: Trauma, Early warning, Clinical deterioration, Hospital length of stay

Changde Wu, Hui Yang, Lingjuan Liu, Yufen Zhu, Liwei Huang, Songqiao Liu, Yi Yang. Impact of a real-time critical care early warning platform on clinical outcomes in orthopedic trauma patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(03): 238-243.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2025.03.005

https://icu.cma-cmc.com.cn/EN/Y2025/V11/I03/238

Figures/Tables 5

临床特征	总数（189例）	预警组（68例）	非预警组（121例）	统计值	P值
女性	83（43.9）	28（41.2）	55（45.5）	χ²=0.173	0.677
年龄[岁，M（Q_R）]	72（57，81）	69（57，76）	74（60，84）	U=4903.500	0.029
入院类型				χ²=1.771	0.183
急诊入院	60（31.7）	17（25.0）	43（35.5）
非急诊入院	129（68.3）	51（75.0）	78（64.5）
基础疾病
高血压	92（48.7）	37（54.4）	55（45.5）	χ²=1.063	0.303
脑卒中	54（28.6）	19（27.9）	35（28.9）	χ²=7.710	>0.999
糖尿病	40（21.2）	17（25.0）	23（19.0）	χ²=0.612	0.434
冠心病	37（19.6）	12（17.6）	25（20.7）	χ²=0.096	0.756
慢性心力衰竭	17（9.0）	5（7.4）	12（9.9）	χ²=0.107	0.744
慢性阻塞性肺疾病	14（7.4）	4（5.9）	10（8.3）	χ²=0.097	0.756
慢性肾功能不全	9（4.8）	2（2.9）	7（5.8）	-	0.492
创伤部位				χ²=10.612	0.001
脊柱创伤	75（39.7）	38（55.9）	37（30.6）
非脊柱创伤	114（60.3）	30（44.1）	84（69.4）

指标	总数（189例）	预警组（68例）	非预警组（121例）	统计值	P值
病情严重程度评分[分，M（Q_R）]
序贯器官衰竭评估评分	4（2，6）	3（2，5）	5（3，7）	U=5039	0.010
急性生理与慢性健康评价评分	14（11，8）	13（11，17）	14（12，18）	U=4668	0.124
器官功能不全发生率[例（%）]
休克	27（14.3）	8（11.8）	19（15.7）	χ²=0.277	0.599
呼吸衰竭	26（13.8）	10（14.7）	16（13.2）	χ²=0.004	0.949
临床结局
ICU住院时间（d， $x ¯$ ±s）	8±13	5±9	10±15	t=2.751	0.017
住院时间[d，M（Q_R）]	15（11，22）	13（10，18）	16（12，28）	U=5110	0.006
非计划转ICU[例（%）]	67（35.4）	16（23.5）	51（42.1）	χ²=5.807	0.016
住院总费用[元，M（Q_R）]	108 441（74 481，163 419）	101 398（74 959，142 113）	114 837（72 636，183 233）	U=1.930	0.055
住院病死率[例（%）]	13（6.9）	4（5.9）	9（7.4）	χ²=0.011	0.915

指标	总数（189例）	预警组（68例）	非预警组（121例）	统计值	P值
病情严重程度评分[分，M（Q_R）]
序贯器官衰竭评估评分	4（2，6）	3（2，5）	5（3，7）	U=5039	0.010
急性生理与慢性健康评价评分	14（11，8）	13（11，17）	14（12，18）	U=4668	0.124
器官功能不全发生率[例（%）]
休克	27（14.3）	8（11.8）	19（15.7）	χ²=0.277	0.599
呼吸衰竭	26（13.8）	10（14.7）	16（13.2）	χ²=0.004	0.949
临床结局
ICU住院时间（d， $x ¯$ ±s）	8±13	5±9	10±15	t=2.751	0.017
住院时间[d，M（Q_R）]	15（11，22）	13（10，18）	16（12，28）	U=5110	0.006
非计划转ICU[例（%）]	67（35.4）	16（23.5）	51（42.1）	χ²=5.807	0.016
住院总费用[元，M（Q_R）]	108 441（74 481，163 419）	101 398（74 959，142 113）	114 837（72 636，183 233）	U=1.930	0.055
住院病死率[例（%）]	13（6.9）	4（5.9）	9（7.4）	χ²=0.011	0.915

因素指标	OR值	95%CI	回归系数	标准误	t值	P值
年龄	0.930	0.80~1.09	-0.07	0.08	0.87	0.386
序贯器官衰竭评估评分	1.850	0.84~4.10	0.62	0.41	1.52	0.131
女性	0.080	0~11.40	-2.57	2.55	1.01	0.315
脊柱损伤	0.460	0~80.80	-0.78	2.64	0.30	0.767
重症预警平台	0.003	0~0.47	-5.91	2.63	2.25	0.026

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