Supplementary Digital Content 3: The Medical Emergency Team Calling Criteria systems evaluated in the study and their trigger criteria.
Pulse rate
beats.m-1
Lower
Upper
Bell (MET criteria)
< 40
Bell (Extended)
< 50
Bell (Restricted)
Breathing rate
breaths.m-1
Systolic BP
mmHg
Reduced
consciousness
SpO2 (%)
FiO2
< 90
*
<90
>0.21
< 100
*
<90
>0.21
*
<90
>0.21
<90
>0.35
●
<90
>0.21
< 90
●
<90
>0.24
> 36
< 90
●
<85
>0.21
<6
> 30
< 90
●
<90
>0.21
Lower
Upper
> 130
<8
> 30
> 120
< 10
> 28
< 35
> 140
<6
> 32
< 80
Ball
< 50
> 125
<8
> 25
< 90
> 200
Parissopoulos
< 45
> 125
<8
> 25
< 90
> 200
Hickey
< 45
> 125
<8
> 30
Salamonson
< 40
> 140
<6
> 130
Buist
Temperature
o
C
Lower
Upper
Lower
Upper
> 38.0
Bellomo
< 40
> 130
<8
> 30
< 90
●
<90
>0.21
Jones
< 40
> 130
<8
> 30
< 90
●
<90
>0.21
Green
< 40
> 120
<5
> 30
< 90
●
<90
>0.21
Harrison (Early)
< 50
> 120
< 10
> 30
< 100
> 180
●
<95
>0.21
Harrison (Late)
< 40
> 140
<5
> 40
< 80
> 240
●
<90
>0.21
> 25
< 95
> 200
< 35.0
> 38.0
●
> 30
< 100
> 200
< 35.5
> 39.5
●
> 30
< 90
> 200
< 35.0
> 40.0
●
< 85
>0.21
Smith
> 100
Lee
< 40
> 120
Buist
< 50
> 130
< 10
Page 1
Reference
Bell MB, Konrad D, Granath F, Ekbom A, Martling C. Prevalence
and sensitivity of MET-criteria in a Scandinavian University
Hospital. Resuscitation 2006;70:66-73.
Ball C. Critical care outreach services--do they make a
difference? Intensive Crit Care Nurs 2002;18:257-60.
Parissopoulos S, Kotzabassaki S. Critical care outreach and the
use of early warning scoring systems; a literature review. ICUs
Nurs Web J 2005;21: 1-11.
Hickey C, Allen M. A critical care liaison service. British Journal
of Anaesthesia 1998;81:650.
Salamonson Y, Kariyawasam A, van Heere B, O’Connor C. The
evolutionary process of Medical Emergency Team (MET)
implementation: reduction in unanticipated ICU transfers.
Resuscitation 2001;49:135-41.
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN,
Nguyen TV Effects of a medical emergency team on reduction
of incidence of and mortality from unexpected cardiac arrests in
hospital: preliminary study. BMJ 2002;324:387-90.
Bellomo R, Goldsmith D, Uchino S et al. A prospective beforeand-after trial of a medical emergency team. Med J Aust
2003;179:283-7.
Jones D, Bates S, Warrillow S et al. Circadian pattern of
activation of the medical emergency team in a teaching hospital.
Crit Care 2005;9:R303-306.
Green AL, Williams A. An evaluation of an early warning clinical
marker referral tool. Intensive Crit Care Nurs 2006;22:274-82.
Harrison GA, Jacques TC, Kilborn G, McLaws M. The
prevalence of recordings of the signs of critical conditions and
emergency responses in hospital wards--the SOCCER study.
Resuscitation 2005;65:149-57.
Smith AF, Wood J. Can some in-hospital cardio-respiratory
arrests be prevented? A prospective survey. Resuscitation
1998;37:133-7.
Lee A, Bishop G, Hillman KM, Daffurn K. The Medical
Emergency Team. Anaesth Intensive Care 1995;23:183-6.
Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP,
Anderson J.Recognising clinical instability in hospital patients
before cardiac arrest or unplanned admission to intensive care.
A pilot study in a tertiary-care hospital. Med J Aust 1999;171:22-
5.
McGloin
< 60
de Pennington
> 120
<10
> 120
> 25
< 100
> 30
< 90
> 200
< 35.5
> 38.5
●
> 39.0
●
<90
>0.21
●
McArthur-Rouse
< 40
> 120
<5
> 36
< 90
Foraida
< 40
> 140
<8
> 36
< 80
> 200
●
<85
>0.21
Cioffi
< 40
> 140
<8
> 36
< 90
> 200
●
< 85
>0.21
Holder
< 45
> 125
<8
> 25
< 90
> 200
●
<90
>0.21
Buist
< 50
> 130
<6
> 30
< 90
> 200
●
<90
>0.21
McQuillan
< 40
> 140
<8
> 30
< 90
●
Hourihan
< 40
> 140
<5
> 36
< 90
●
Bristow
< 40
> 140
<5
> 36
< 90
●
> 130
<8
> 30
●
<90
>0.21
●
<90
>0.21
Jones
Subbe
< 40
> 140
<5
> 36
Jacques (Late)
< 40
> 140
<5
> 40
< 80
●
Offner
< 40
> 130
<8
> 24
< 90
●
> 130
<8
> 30
< 90
●
<90
>0.21
<90
>0.21
Jones
Jones
< 40
> 140
<8
> 36
< 90
●
Parr
< 40
> 140
<5
> 35
< 90
●
Page 2
McGloin H, Adam SK, Singer M. Unexpected deaths and
referrals to intensive care of patients on general wards. Are
some cases potentially avoidable? J R Coll Physicians Lond
1999;33:255-9.
de Pennington J, Laurenson J, Lebus C, Sihota S, Smith P.
Evaluation of Early Warning Systems on a medical admissions
unit. J Intensive Care Soc 2005;6:19-21.
McArthur-Rouse F. Critical care outreach services and early
warning scoring systems: a review of the literature. J Adv Nurs
2001;36:696-704.
Foraida MI, DeVita MA, Braithwaite RS, Stuart S, Brooks M,
Simmons R. Improving the utilization of medical crisis teams
(Condition C) at an urban tertiary care hospital. J Crit Care
2003;18:87-94.
Cioffi J, Salter C, Wilkes L, Vonu-Boriceanu O, Scott J.
Clinicians' responses to abnormal vital signs in an emergency
department. Aust Crit Care 2006;19:66-72.
Holder P, Cuthbertson BH. Critical care outwith the intensive
care unit. Clin Med 2005;5:449-51.
Buist M, Bernard S, Nguyen TV Moore G., Anderson, J.
Association between clinically abnormal observations and
subsequent in-hospital mortality: a prospective study.
Resuscitation 2004;62:137-41.
McQuillan P, Pilkington S, Allan A et al. Confidential inquiry into
quality of care before admission to intensive care. BMJ
1998;316:1853-8.
Hourihan F, Bishop G, Hillman K Daffurn K, Lee A. et al. The
Medical Emergency Team: a new strategy to identify and
intervene in high-risk patients. Clin Intens Care 1995;6:269-72.
Bristow PJ, Hillman KM, Chey T et al. Rates of in-hospital
arrests, deaths and intensive care admissions: the effect of a
medical emergency team. Med J Aust 2000;173:236-40.
Jones D, Bellomo R, Leong T. Using an MET service to manage
an acute thromboembolic stroke. Jt Comm J Qual Patient Saf
2006;32:361-5, 357.
Subbe CP, Gao H, Harrison DA. Reproducibility of physiological
track-and-trigger warning systems for identifying at-risk patients
on the ward. Intensive Care Med 2007; 33: 619-24.
Jacques T, Harrison GA, McLaws ML, Kilborn G. Signs of critical
conditions and emergency responses (SOCCER): a model for
predicting adverse events in the inpatient setting. Resuscitation
2006;69:175-83
Offner PJ, Heit J, Roberts R. Implementation of a rapid response
team decreases cardiac arrest outside of the intensive care unit.
J Trauma 2007;62:1223-8.
Jones D, Bellomo R, Bates S et al. Patient monitoring and the
timing of cardiac arrests and medical emergency team calls in a
teaching hospital. Intensive Care Med 2006;32:1352-6.
Parr MJ, Hadfield JH, Flabouris A, Bishop G, Hillman K. The
Medical Emergency Team: 12 month analysis of reasons for
activation, immediate outcome and not-for-resuscitation orders.
Resuscitation 2001;50:39-44.
Cretikos original
> 140
> 36
< 90
●
Cretikos set 1
> 120
> 25
< 90
●
Cretikos set 2
> 125
> 25
< 90
●
Cretikos set 3
> 120
> 25
< 85
●
Cretikos set 4
> 125
> 25
< 85
●
Cretikos set 5
> 130
> 25
< 85
●
Cretikos set 6
> 140
> 25
< 85
●
Cretikos set 7
> 140
> 26
< 85
●
Cretikos set 8
> 140
> 28
< 85
●
Cretikos set 9
> 140
> 28
< 80
●
Cretikos set 10
> 140
> 30
< 80
●
Page 3
Cretikos, M., Chen, J., Hillman, K, et al. A. The objective medical
emergency team activation criteria: a case-control study.
Resuscitation 2007; 73:62-72.