非重症监护病房医院环境中的临床监测技术：随机试验的系统评价与贝叶斯网络荟萃分析。
完整摘要 · 中文译文
背景：未能识别住院患者的临床恶化促使了基于规则的电子监测（RB-ES）、基于预测模型的电子监测（PM-ES）和连续生理监测（CPM）的发展。然而，它们对以患者为中心结局的比较效果仍不确定。 目的：本研究旨在比较紧急重症基于规则的电子监测、基于预测模型的电子监测、连续生理监测与当地标准护理在非重症监护病房住院环境中的临床效果。 方法：我们检索了PubMed、在线Embase、通过Cochrane图书馆检索的Cochrane对照试验中央注册库，以及Web of Science核心合集，检索时间从建库至2026年2月28日。针对性补充监测，包括试验注册库随访、后向和前向引文追踪，以及对已注册试验新可获得报告的已知条目检索，持续至2026年7月22日。随机、整群随机、随机交叉和阶梯楔形试验符合纳入条件。干预措施根据其主要随机化功能而非其商业或算法标签进行分类。主要结局为全因院内死亡或至30天死亡，以及非计划或紧急重症监护病房转入。使用研究水平调整相对效应进行贝叶斯随机效应网络荟萃分析。次要结局使用特定构念的成对荟萃分析进行评估。偏倚风险使用适当的RoB 2工具进行评估，网络估计的置信度采用人工 采用CINeMA（网络荟萃分析可信度评估）框架进行评估。试验序贯分析作为探索性补充分析保留。 结果：该综述纳入了28项独立试验。9项符合严格的数字监测标准；7项至少贡献于1个网络，而2项因结局定义或零事件限制仅贡献于敏感性分析。6项试验共13，716例观察数据贡献于死亡率网络。与标准监护相比，RB-ES的优势比为0.91（95%可信区间[CrI] 0.35-2.30），PM-ES为1.22（95% CrI 0.61-2.31），CPM为0.70（95% CrI 0.36-1.29）。6项试验共13，441例观察数据贡献于重症监护室转诊网络。相应的优势比分别为1.20（95% CrI 0.56-2.59）、0.95（95% CrI 0.58-1.52）和0.70（95% CrI 0.37-1.28）。扩展的基于规则的监测-响应系统未显著减少心脏骤停或心肺复苏（OR 0.94，95% CI 0.77-1.14）。CPM（均值比0.91，95% CI 0.76-1.09）和基于预测模型的监测（均值比0.99，95% CI 0.47-2.08）对住院时间未见明确效应。试验序贯分析结果不确定。所有网络比较的可信度均非常低。 结论：当前随机证据未在RB-ES、PM-ES和CPM之间确立可靠的临床有效性等级。连续监测显示多项结局具有方向性有利但精度不足的估计值。因此，监测策略的选择不应仅依据 到算法类别或预测复杂性；其临床效果也可能取决于目标人群、背景监测、工作流程整合、警报呈现方式以及临床应对路径。
完整摘要 · 英文原文
BACKGROUND: Failure to recognize clinical deterioration in hospitalized patients has prompted the development of rule-based electronic surveillance (RB-ES), predictive model-based electronic surveillance (PM-ES), and continuous physiologic monitoring (CPM). However, their comparative effects on patient-centered outcomes remain uncertain. OBJECTIVE: The aim of this study is to compare the clinical effects of emergent intensive RB-ES, PM-ES, CPM, and local standard care in nonintensive care unit hospital settings. METHODS: We searched PubMed, Embase via online, the Cochrane Central Register of Controlled Trials via the Cochrane Library, and the Web of Science Core Collection from inception through February 28, 2026. Targeted supplementary surveillance, including trial-registry follow-up, backward and forward citation tracking, and known-item searches for newly available reports of registered trials, continued through July 22, 2026. Randomized, cluster-randomized, randomized crossover, and stepped-wedge trials were eligible. Interventions were classified according to their principal randomized function rather than their commercial or algorithmic labels. The primary outcomes were all-cause in-hospital or up-to-30-day mortality, and unplanned or emergent intensive care unit transfers. Bayesian random-effects network meta-analyses were performed using study-level adjusted relative effects. Secondary outcomes were evaluated using construct-specific pairwise meta-analyses. Risk of bias was assessed using the appropriate RoB 2 tool, and confidence in the network estimates was manually evaluated using the CINeMA (Confidence in Network Meta-Analysis) framework. Trial sequential analysis was retained as an exploratory supplementary analysis. RESULTS: The review included 28 independent trials. Nine met strict digital-surveillance criteria; 7 contributed to at least 1 network, while 2 contributed only to sensitivity analyses because of outcome-definition or zero-event limitations. Six trials with 13,716 observations contributed to the mortality network. Compared with standard care, odds ratios were 0.91 (95% credible interval [CrI] 0.35-2.30) for RB-ES, 1.22 (95% CrI 0.61-2.31) for PM-ES, and 0.70 (95% CrI 0.36-1.29) for CPM. Six trials with 13,441 observations contributed to the intensive care unit transfer network. Corresponding odds ratios were 1.20 (95% CrI 0.56-2.59), 0.95 (95% CrI 0.58-1.52), and 0.70 (95% CrI 0.37-1.28), respectively. Expanded rule-based surveillance-response systems did not clearly reduce cardiac arrest or cardiopulmonary resuscitation (OR 0.94, 95% CI 0.77-1.14). CPM (ratio of means 0.91, 95% CI 0.76-1.09) and predictive model-based surveillance (ratio of means 0.99, 95% CI 0.47-2.08) showed no clear effect on hospital length of stay. Trial sequential analyses were inconclusive. Confidence in all network comparisons was very low. CONCLUSIONS: Current randomized evidence does not establish a reliable clinical-effectiveness hierarchy among RB-ES, PM-ES, and CPM. Continuous monitoring showed directionally favorable but imprecise estimates for several outcomes. Surveillance strategies should therefore not be selected solely according to algorithm class or predictive complexity; their clinical effects may also depend on the target population, background monitoring, workflow integration, alert presentation, and clinical response pathway.