Correction to: Early warning scores and critical care transfer – patient heterogeneity, low sensitivity, high mortality

Abstract Background Emergency warning systems (EWS) are becoming a standard of care, but have unproven screening value in early critical illness. Similarly, emergency response team (ERT) care is of uncertain value. These questions are most controversial in mixed patient populations, where screening performance might vary, and intensivist-led ERT care might divert resources from existing patients. Aims To examine triggering events, disposition and outcome data for an intensivist-staffed EWS-ERT system. Methods We analysed process and outcome data over three years, classing EWS-triggered patients into three categories (non-escalated, escalated ward care and critical care transfer). The relationships between EWS data, pre-triggering clinical data, and patient disposition and outcome were examined. Results There were 1675 calls in 1190 patients. Most occurred later during admission, with critical care transfer in a minority; the rest were followed by escalated or non-escalated ward care. Patients transferred to critical care had high mortality (40.3%); less than half of patient transfers occurred following triggering EWS score predicted overall hospital mortality, but not mortality after critical care. Conclusions In a diverse hospital population, most triggering patients did not receive critical care and most critical care transfers occurred without triggering. Triggering was an insensitive screening measure for critical illness, followed by poor outcome. Higher scores predicted higher probability of transfer, but not later mortality, suggesting that EWS is being used as a decision aid but is not a true severity of illness score. Other, non-EWS data are needed for earlier detection and for prioritizing access to critical care.

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Resuscitation

10.1093/med/9780199683819.003.0006 ◽

2014 ◽

Author(s):

Tim Raine ◽

James Dawson ◽

Stephan Sanders ◽

Simon Eccles

Keyword(s):

Critical Care ◽

Early Warning ◽

Basic Life Support ◽

Life Support ◽

Advanced Life Support ◽

Advanced Trauma Life Support ◽

Improve Outcome ◽

Early Warning Scores

Early warning scoresPeri-arrestIn-hospital resuscitationAdvanced Life Support (ALS)Arrest equipment and testsAdvanced Trauma Life Support (ATLS)Paediatric Basic Life SupportNewborn Life Support (NLS)Obstetric arrestof the ‘unwell’ patient has repeatedly been shown to improve outcome. Identification of such patients allows suitable changes in management, including early involvement of critical care teams or transfer to critical care areas (HDU/ICU) where necessary....

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National early warning scores on critical care unit discharge do not predict readmission: A retrospective case–control study

Resuscitation ◽

10.1016/j.resuscitation.2017.08.201 ◽

2017 ◽

Vol 118 ◽

pp. e83-e84

Author(s):

Reza Khorasanee ◽

Christopher Chadwick ◽

Daniel Hiley ◽

Jonathan Hulme

Keyword(s):

Critical Care ◽

Early Warning ◽

Critical Care Unit ◽

Case Control Study ◽

Case Control ◽

Retrospective Case ◽

Unit Discharge ◽

Early Warning Scores ◽

Control Study

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National Early Warning Scores on Critical Care Unit Discharge Do Not Predict Readmission: A Retrospective Case-Control Study

10.26226/morressier.59b171e9d462b8028d896100 ◽

2017 ◽

Author(s):

Reza Khorasanee

Keyword(s):

Critical Care ◽

Early Warning ◽

Critical Care Unit ◽

Case Control Study ◽

Case Control ◽

Retrospective Case ◽

Unit Discharge ◽

Early Warning Scores ◽

Control Study

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Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044091 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044091

Author(s):

Sam T Romaine ◽

Gerri Sefton ◽

Emma Lim ◽

Ruud G Nijman ◽

Jolanta Bernatoniene ◽

...

Keyword(s):

Emergency Department ◽

Critical Care ◽

Cohort Study ◽

Early Warning ◽

Best Practice ◽

Predictive Performance ◽

Hospital Length Of Stay ◽

Suspected Sepsis ◽

Early Warning Scores ◽

Related Mortality

ObjectivePaediatric Early Warning Scores (PEWS) are widely used in the UK, but the heterogeneity across tools and the limited data on their predictive performance represent obstacles to improving best practice. The standardisation of practice through the proposed National PEWS will rely on robust validation. Therefore, we compared the performance of the National PEWS with six other PEWS currently used in NHS hospitals, for their ability to predict critical care (CC) admission in febrile children attending the emergency department (ED).DesignRetrospective single-centre cohort study.SettingTertiary hospital paediatric ED.ParticipantsA total of 11 449 eligible febrile ED attendances were identified from the electronic patient record over a 2-year period. Seven PEWS scores were calculated (Alder Hey, Bedside, Bristol, National, Newcastle and Scotland PEWS, and the Paediatric Observation Priority Score, using the worst observations recorded during their ED stay.OutcomesThe primary outcome was CC admission within 48 hours, the secondary outcomes were hospital length of stay (LOS) >48 hours and sepsis-related mortality.ResultsOf 11 449 febrile children, 134 (1.2%) were admitted to CC within 48 hours of ED presentation, 606 (5.3%) had a hospital LOS >48 hours. 10 (0.09%) children died, 5 (0.04%) were sepsis-related. All seven PEWS demonstrated excellent discrimination for CC admission (range area under the receiver operating characteristic curves (AUC) 0.91–0.95) and sepsis-related mortality (range AUC 0.95–0.99), most demonstrated moderate discrimination for hospital LOS (range AUC 0.69–0.75). In CC admission threshold analyses, bedside PEWS (AUC 0.90; 95% CI 0.86 to 0.93) and National PEWS (AUC 0.90; 0.87–0.93) were the most discriminative, both at a threshold of ≥6.ConclusionsOur results support the use of the proposed National PEWS in the paediatric ED for the recognition of suspected sepsis to improve outcomes, but further validation is required in other settings and presentations.

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Early warning scores: breaking or building barriers to critical care

Critical Care ◽

10.1186/cc13234 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P44

Author(s):

E Dunne ◽

RO Leary ◽

K Srinivasan ◽

B Ahmed ◽

D Galvin ◽

...

Keyword(s):

Critical Care ◽

Early Warning ◽

Early Warning Scores

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Preoperative Early Warning Scores Can Predict In-Hospital Mortality and Critical Care Admission Following Emergency Surgery

Journal of Surgical Research ◽

10.1016/j.jss.2008.08.013 ◽

2010 ◽

Vol 159 (2) ◽

pp. 729-734 ◽

Cited By ~ 25

Author(s):

Giuseppe Garcea ◽

Ramarao Ganga ◽

Christopher P. Neal ◽

Seok L. Ong ◽

Ashley R. Dennison ◽

...

Keyword(s):

Critical Care ◽

Hospital Mortality ◽

Early Warning ◽

Emergency Surgery ◽

Early Warning Scores ◽

Critical Care Admission

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National Early Warning Scores And COVID-19 Deaths In Care Homes: An Ecological Time Series Study

Innovation in Aging ◽

10.1093/geroni/igaa057.3517 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 962-963

Author(s):

Daniel Stow ◽

Robert Barker ◽

Fiona Matthews ◽

Barbara Hanratty

Keyword(s):

Time Series ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Early Warning ◽

Disease Surveillance ◽

Care Home ◽

Outcome Data ◽

Care Homes ◽

Individual Level ◽

Early Warning Scores

Abstract Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths. We conclude that NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

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Cases in Paediatric Critical Care Transfer and Retrieval Medicine

10.1017/9781108946438 ◽

2021 ◽

Keyword(s):

Emergency Medicine ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Transfer Process ◽

The Past ◽

Clinical Presentations ◽

Paediatric Critical Care ◽

Care Transfer ◽

Case Based

Critically ill paediatric transfers have expanded rapidly over the past ten years and, as such, the need for transfer teams to recognise, understand and treat the various illnesses that they encounter is greater than ever. This highly illustrated book covers a multitude of clinical presentations in a case-based format to allow an authentic feel to the transfer process. Written by clinicians with experience in thousands of transfers, it brings together many years of experience from a world-renowned hospital. Following the case from initial presentation, to resuscitation and referral and finally with the transfer itself; the book explores the clinical stabilisation, human factors decisions and logistical challenges that are encountered every day by these teams. Following the entire journey, this is an ideal resource for all professionals who may be involved in critical care transfer and retrieval medicine, particularly those working in paediatrics, emergency medicine, anaesthesiology, intensive care, or pre-hospital settings.

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