Observational studyCritical care explorations2024
Causes, Diagnostic Testing, and Treatments Related to Clinical Deterioration Events Among High-Risk Ward Patients.
Observational study in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Clinical heterogeneity in performance of a commercial prediction model for clinical deterioration.BMJ health & care informatics · 2026Article
- Treatment Recommendations for Clinical Deterioration on the Wards: Development and Validation of Machine Learning Models.JMIR AI · 2026Article
- Evaluating sociodemographic bias in a deployed machine-learned patient deterioration model.JAMIA open · 2025Article
- Implementation of Passive Deterioration Index Alerts in an Intermediate Care Unit: A Failed Early Warning System Strategy.Applied clinical informatics · 2025Article
- Uncertainty estimation in diagnosis generation from large language models: next-word probability is not pre-test probability.JAMIA open · 2025Article
- A machine learning model based on emergency clinical data predicting 3-day in-hospital mortality for stroke and trauma patients.Frontiers in neurology · 2025Article
- When Raw Data Prevails: Are Large Language Model Embeddings Effective in Numerical Data Representation for Medical Machine Learning Applications?Findings of ACL. EMNLP. Conference on Empirical Methods in Natural Language Processing · 2024Article
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Abstract
importanceTimely intervention for clinically deteriorating ward patients requires that care teams accurately diagnose and treat their underlying medical conditions. However, the most common diagnoses leading to deterioration and the relevant therapies provided are poorly characterized.
objectivesWe aimed to determine the diagnoses responsible for clinical deterioration, the relevant diagnostic tests ordered, and the treatments administered among high-risk ward patients using manual chart review. DESIGN, SETTING, AND
participantsThis was a multicenter retrospective observational study in inpatient medical-surgical wards at four health systems from 2006 to 2020. Randomly selected patients (1000 from each health system) with clinical deterioration, defined by reaching the 95th percentile of a validated early warning score, electronic Cardiac Arrest Risk Triage, were included. MAIN OUTCOMES AND MEASURES: Clinical deterioration was confirmed by a trained reviewer or marked as a false alarm if no deterioration occurred for each patient. For true deterioration events, the condition causing deterioration, relevant diagnostic tests ordered, and treatments provided were collected.
resultsOf the 4000 included patients, 2484 (62%) had clinical deterioration confirmed by chart review. Sepsis was the most common cause of deterioration (41%; n = 1021), followed by arrhythmia (19%; n = 473), while liver failure had the highest in-hospital mortality (41%). The most common diagnostic tests ordered were complete blood counts (47% of events), followed by chest radiographs (42%) and cultures (40%), while the most common medication orders were antimicrobials (46%), followed by fluid boluses (34%) and antiarrhythmics (19%). CONCLUSIONS AND RELEVANCE: We found that sepsis was the most common cause of deterioration, while liver failure had the highest mortality. Complete blood counts and chest radiographs were the most common diagnostic tests ordered, and antimicrobials and fluid boluses were the most common medication interventions. These results provide important insights for clinical decision-making at the bedside, training of rapid response teams, and the development of institutional treatment pathways for clinical deterioration.
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