Bedside vital parameters that indicate early deterioration

2019 ◽  
Vol 32 (1) ◽  
pp. 262-272 ◽  
Author(s):  
Gitte Bunkenborg ◽  
Ingrid Poulsen ◽  
Karin Samuelson ◽  
Steen Ladelund ◽  
Jonas Akeson

Purpose The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4). Design/methodology/approach This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals. Findings Respiratory rate, heart rate and patient age were significantly (p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also (p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not. Practical implications It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related. Originality/value Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.

2019 ◽  
Vol 61 (3) ◽  
pp. 78
Author(s):  
L. A. Adebusoye ◽  
M. O. Owolabi ◽  
A. Ogunniyi

Background: Biomarkers, shock index and modified early warning score (MEWS) are of public health importance because identification and prompt attention to them have been found to reduce mortality among older patients on admission.Objectives: A study was undertaken to determine the biomarkers, shock index and MEWS that predict mortality on admission among older medical hospital inpatients.Methods: This was a prospective study of 450 patients (≥ 60 years) on the medical wards of University College Hospital, Ibadan. Biomarkers recommended by the National Institute on Aging such as blood pressure, heart rate and pulse rate (cardiovascular functioning); cholesterol and triglycerides (metabolic processes); T-cell counts (immune system status) and weight, body mass index and waist-to-hip ratio (indicators of obesity, chronic metabolic disorders and fat deposits) were assessed. Vital signs were recorded on admission and used to calculate the shock index and MEWS. Multivariate and survival analyses were carried out at p 0.05.Results: Baseline temperature ≥ 39.0°c (p = 0.049), pulse rate ≥ 100 beats/minute (p = 0.034), systolic blood pressure (SBP) 120 mmHg (p = 0.048), shock index ≥1.0 (p = 0.041), age shock index (p = 0.032) and critical illness score (MEWS ≥5) p = 0.019 were significantly associated with mortality. Independent predictors of mortality on Cox regression analysis were temperature ≥ 39.0°C (HR = 3.317 [1.281–8.590]) and SBP 120 mmHg (HR = 1.845 [1.025–3.322]).Conclusion: Prompt identification and management of fever and low blood pressure should improve the survival of older medical hospital inpatients.


2020 ◽  
Vol 23 (8) ◽  
pp. 536-541
Author(s):  
Huseyin Aygun ◽  
Suna Eraybar ◽  
Fatma Ozdemir ◽  
Erol Armagan

Background: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. Methods: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients’ health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. Results: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%–82.0%) for hospitalization and 76.24% (95% CI 71.5–80.5) for mortality; the specificity was 69.52 (95% CI 62.8–75.7) for hospitalization and 90.65 (95% CI 84.65–94.9) for mortality. Conclusion: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.


Author(s):  
Jeremy Zhenwen Pong ◽  
Stephanie Fook-Chong ◽  
Zhi Xiong Koh ◽  
Mas’uud Ibnu Samsudin ◽  
Takashi Tagami ◽  
...  

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.


2015 ◽  
Vol 28 (8) ◽  
pp. 872-875 ◽  
Author(s):  
Gary B Smith ◽  
David R Prytherch ◽  
Paul Meredith ◽  
Paul E Schmidt

Purpose – The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used. Design/methodology/approach – The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation. Findings – Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff. Practical implications – EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use. Originality/value – The paper raises the EWS debate and alerts EWS users that scrutiny is required.


2019 ◽  
Vol 72 (6) ◽  
pp. 1428-1434 ◽  
Author(s):  
Sayane Marlla Silva Leite Montenegro ◽  
Carlos Henrique Miranda

ABSTRACT Objective: To evaluate the performance of the modified early warning score (Mews) in a nursing ward for patients in clinical deterioration. Method: This is an analytical, quantitative and predictive study. Mews’ parameters (systolic blood pressure, heart rate, respiratory rate, temperature and level of consciousness) were evaluated every six hours. The following events were reported: death, cardiopulmonary arrest and transfer to intensive care. The evaluations were performed in a hospital of reference in the state of São Paulo, Brazil. Results: A total of 300 patients were included (57 ± 18 years old, males: 65%). There number of combined events was observed to be greater the higher the score’s value (00%; 00%; 01; 09%; 19%; 28%; 89%, respectively, for Mews 0; 1; 2; 3; 4; 5 and 6; p < 0.0001). Mews ≥ 4 was the most appropriate cut-off point for prediction of these events (sensitivity: 87%, specificity: 85% and accuracy: 0.86). Conclusion: Mews properly measured the occurrence of severe events in hospitalized patients of a Brazilian public hospital’s nursing ward. Mews ≥ 4 seems to be the most appropriate cut-off point for prediction of these events.


2018 ◽  
Vol 12 (11) ◽  
pp. 3154
Author(s):  
Ana Paula Amestoy De Oliveira ◽  
Janete De Souza Urbanetto ◽  
Rita Catalina Aquino Caregnato

RESUMOObjetivo: realizar a tradução e a adaptação transcultural da National Early Warning Score 2 (NEWS2) e validar o uso, no Brasil, para a deterioração clínica de pacientes. Método: trata-se de estudo metodológico. Fundamentar-se-á o processo no modelo de Beaton e colaboradores seguindo-se seis etapas: tradução inicial, síntese das traduções, tradução reversa, comitê de especialistas, teste de versão final e auditoria do processo. Realizar-se-á o teste de versão final em um hospital universitário do Sul do Brasil, com amostra de 40 enfermeiros, que aplicarão a escala a três estudos de caso propostos pelas pesquisadoras. Transcrever-se-ão e analisar-se-ão as respostas por meio do coeficiente de Kappa avaliando-se a concordância dos observadores. Realizar-se-á, para a validação, um estudo de coorte avaliando-se os registros de Enfermagem dos pacientes admitidos na emergência, em maio de 2018, e os desfechos óbito ou transferência não programada para a terapia intensiva em 24h, 48h e 72h. Respeitar-se-ão, pelo estudo, os aspectos éticos obtendo-se, como produto educativo, a escala NEWS2 traduzida e adaptada ao português brasileiro. Resultados esperados: pretende-se traduzir, adaptar e validar a NEWS produzindo-se um produto de valia para a assistência aos pacientes. Descritores: Pacientes; Evolução Clínica; Avaliação; Tradução; Estudos de Validação; Segurança.ABSTRACTObjective: to perform translation and cross-cultural adaptation of the National Early Warning Score 2 (NEWS2) and to validate the use in Brazil of clinical deterioration of patients. Method: this is a methodological study. The process will be based on the model of Beaton and collaborators following six steps: initial translation, synthesis of translations, reverse translation, committee of experts, final version test and process audit. The final version will be tested in a university hospital in the South of Brazil, with a sample of 40 nurses, who will apply the scale to three case studies proposed by the researchers. Transcripts will be transcribed and analyzed using the Kappa coefficient and the agreement of the observers will be evaluated. A cohort study will be performed for the validation of the Nursing records of patients admitted to the emergency room in May 2018, and the outcomes of death or unscheduled transfer to intensive care in 24 hours, 48 hours and 72 hours. The ethical aspects will be respected by the study, obtaining as an educational product the NEWS2 scale translated and adapted to Brazilian Portuguese. Expected results: we intend to translate, adapt and validate NEWS producing a valuable product for patient care. Descriptors: Patients; Clinical Evolution; Evaluation; Translating; Validation Studies; Safety.RESUMEN Objetivo: realizar la traducción y la adaptación transcultural de la National Early Warning Score 2 (NEWS2) y validar el uso, en Brasil, para el deterioro clínico de pacientes. Método: se trata de un estudio metodológico. Se fundamenta el proceso en el modelo de Beaton y colaboradores siguiendo seis etapas: traducción inicial, síntesis de las traducciones, traducción inversa, comité de expertos, prueba de versión final y auditoría del proceso. Se realizará la prueba de versión final en un hospital universitario del sur de Brasil, con muestra de 40 enfermeros, que aplicarán la escala a tres estudios de caso propuestos por las investigadoras. Se transcriben y se analizarán las respuestas a través del coeficiente de Kappa evaluando la concordancia de los observadores. Se realizará, para la validación, un estudio de cohorte evaluando los registros de Enfermería de los pacientes admitidos en la emergencia, en mayo de 2018, y los resultados óbito o transferencia no programada para la terapia intensiva en 24h, 48h y 72h. El respeto será, por el estudio, los aspectos éticos de obtener, como un producto educativo, la escala News2 traducido y adaptado al portugués de Brasil. Resultados esperados: se pretende traducir, adaptar y validar la NEWS produciéndose un producto de valor para la asistencia a los pacientes. Descriptores: Pacientes; Evolución Clínica; Evaluación; Traducción; Estudios de Validación; Seguridad.


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