Exploratory Analysis of 3-Item Bedside Clinical Assessment for Patient Deterioration

Introduction: Early recognition of clinical deterioration is key for timely treatment and prevention of further decline. While many deterioration scores exist, they often include multiple assessment levels and tools to complete. Abnormal mental status (MS), respiratory rate (RR), and capillary refill time (CRT) are known signs of deterioration and easily measured in minutes without tools; however, are not routinely measured in clinical practice. The purpose of this exploratory study was to compare the 3 indicators MS,RR,CRT (MRC) in deteriorating patients during rapid response (RRT) calls with similar patients without RRT calls, hypothesizing that patients with RRT calls have more abnormal MRC values than non-RRT calls and likelihood of transferring to higher levels of care (THLOC).


Methods: During RRT calls, study personnel measured RR for a full minute using a phone app, CRT in seconds, and MS using an adapted AVPU scale for the study (+2 to -4). Patients from similar acuity level units who were stable without RRT calls were assessed using the same procedure. Those with RRT calls were assessed for THLOC, resuscitation status change, and mortality within 3 days of the RRT call.


Results: The sample included Non RRT (n=99) and RRT (n=70) groups with a variety of conditions but from similar units. Significant differences between abnormal MRC scores in RRT call patients and those with no RRT calls were found: MS 51.4% vs 7.1% (P <.0001), CRT 48.6% vs 9.1% (P < .0001), and RR 68.6% vs 19.2% (P < .0001). In the RRT group, 50% were transferred to higher level of care, 3-day post RRT mortality was 7.1% and 14.3% died during hospitalization or changed resuscitation status. The best logistic regression model to predict THLOC used all 3 MRC items. The OR for someone who is abnormal for all 3 tests vs normal for all 3 tests is 13.8 (95% CI 5.6-35).


Conclusions: MRC scores were significantly different in patients who had RRT calls and combining all 3 MRC yielded most predictive of THLOC, with MS being the strongest predictor. This simple clinical exam may be possible for use as an initial assessment of deteriorating patients rapidly without special tools. Study findings were limited due to small sample size and further research is needed to develop predictive models using the MRC tool to detect clinical deterioration.