Modified early warning scores have an equivocal effect on frequency of vital sign measurement

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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Can paediatric early warning scores (PEWS) be used to guide the need for hospital admission and predict significant illness in children presenting to the emergency department? An assessment of PEWS diagnostic accuracy using sensitivity and specificity

Emergency Medicine Journal ◽

10.1136/emermed-2014-204355 ◽

2015 ◽

Vol 33 (5) ◽

pp. 329-337 ◽

Cited By ~ 16

Author(s):

Peter J Lillitos ◽

Graeme Hadley ◽

Ian Maconochie

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Early Warning ◽

Early Warning Scores

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Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period

BMJ Open ◽

10.1136/bmjopen-2017-020269 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020269 ◽

Cited By ~ 3

Author(s):

Sarah Forster ◽

Gemma Housley ◽

Tricia M McKeever ◽

Dominick E Shaw

Keyword(s):

Respiratory Disease ◽

Early Warning ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Scoring Systems ◽

University Hospitals ◽

Retrospective Cohort Analysis ◽

Early Warning Scores ◽

The Impact ◽

Higher Sensitivity

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

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Advance Monitoring of Blood Pressure and Respiratory Rate Using De-Noising Auto Encoder

ASME 2021 30th Conference on Information Storage and Processing Systems ◽

10.1115/isps2021-65921 ◽

2021 ◽

Author(s):

Seung-Ho Park ◽

Kyoung-Su Park

Keyword(s):

Blood Pressure ◽

Respiratory Rate ◽

Vital Sign ◽

Superficial Temporal Artery ◽

Vital Signs ◽

Pulse Signal ◽

Temporal Artery ◽

Sinus Arrhythmia ◽

Vital Signs Monitoring ◽

Vital Sign Measurement

Abstract As the importance of continuous vital signs monitoring increases, the need for wearable devices to measure vital sign is increasing. In this study, the device is designed to measure blood pressure (BP), respiratory rate (RR), and heartrate (HR) with one sensor. The device is in earphone format and is manufactured as wireless type using Arduino-based bluetooth module. The device measures pulse signal in the Superficial temporal artery using Photoplethysmograghy (PPG) sensor. The device uses the Auto Encoder to remove noise caused by movement, etc., contained in the pulse signal. Extract the feature from the pulse signal and use them for the vital sign measurement. The device is measured using Slope transit time (STT) method for BP and Respiratory sinus arrhythmia (RSA) method for RR. Finally, the accuracy is determined by comparing the vital signs measured through the device with the reference vital signs measured simultaneously.

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Resuscitation

Oxford Handbook for the Foundation Programme ◽

10.1093/med/9780198813538.003.0006 ◽

2018 ◽

pp. 225-244

Author(s):

Tim Raine ◽

George Collins ◽

Catriona Hall ◽

Nina Hjelde ◽

James Dawson ◽

...

Keyword(s):

Intensive Care ◽

Early Warning ◽

Basic Life Support ◽

Life Support ◽

Advanced Life Support ◽

Advanced Trauma Life Support ◽

Early Warning Scores

This chapter explores resuscitation, including early warning scores, intensive care, peri-arrest, in-hospital resuscitation, Advanced Life Support (ALS), arrest equipment and tests, Advanced Trauma Life Support (ATLS), Paediatric Basic Life Support, Newborn Life Support (NLS), and obstetric arrest.

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Early identification of severe community-acquired pneumonia: a retrospective observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000438 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000438 ◽

Cited By ~ 1

Author(s):

Frances S Grudzinska ◽

Kerrie Aldridge ◽

Sian Hughes ◽

Peter Nightingale ◽

Dhruv Parekh ◽

...

Keyword(s):

Early Warning ◽

Assessment Tool ◽

Characteristic Curve ◽

Community Acquired Pneumonia ◽

Adverse Outcomes ◽

Assessment Tools ◽

Early Warning Score ◽

News Medium ◽

Increased Risk ◽

Early Warning Scores

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of sepsis worldwide. Prompt identification of those at high risk of adverse outcomes improves survival by enabling early escalation of care. There are multiple severity assessment tools recommended for risk stratification; however, there is no consensus as to which tool should be used for those with CAP. We sought to assess whether pneumonia-specific, generic sepsis or early warning scores were most accurate at predicting adverse outcomes.MethodsWe performed a retrospective analysis of all cases of CAP admitted to a large, adult tertiary hospital in the UK between October 2014 and January 2016. All cases of CAP were eligible for inclusion and were reviewed by a senior respiratory physician to confirm the diagnosis. The association between the CURB65, Lac-CURB-65, quick Sequential (Sepsis-related) Organ Failure Assessment tool (qSOFA) score and National Early Warning Score (NEWS) at the time of admission and outcome measures including intensive care admission, length of hospital stay, in-hospital, 30-day, 90-day and 365-day all-cause mortality was assessed.Results1545 cases were included with 30-day mortality of 19%. Increasing score was significantly associated with increased risk of poor outcomes for all four tools. Overall accuracy assessed by receiver operating characteristic curve analysis was significantly greater for the CURB65 and Lac-CURB-65 scores than qSOFA. At admission, a CURB65 ≥2, Lac-CURB-65 ≥moderate, qSOFA ≥2 and NEWS ≥medium identified 85.0%, 96.4%, 40.3% and 79.0% of those who died within 30 days, respectively. A Lac-CURB-65 ≥moderate had the highest negative predictive value: 95.6%.ConclusionAll four scoring systems can stratify according to increasing risk in CAP; however, when a confident diagnosis of pneumonia can be made, these data support the use of pneumonia-specific tools rather than generic sepsis or early warning scores.

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