Impact of a modified early warning score on nurses' recognition and response to clinical deterioration

2021 ◽  
Author(s):  
Talecia Warren ◽  
Leslie C. Moore ◽  
Sterling Roberts ◽  
Laura Darby
Keyword(s):  
Early Warning ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Recognition And Response

The Use of Prognostic Prediction Models for Mortality or Clinical Deterioration among Hospitalized and Non-hospitalized Adults with COVID-19: A Systematic Review

2021 ◽  
Author(s):  
Patricia Pauline M. Remalante-Rayco ◽  
Evelyn Osio-Salido
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Early Warning ◽  
Prediction Models ◽  
External Validation ◽  
Risk Of Bias ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Good Prediction ◽  
Prediction Of Mortality

Objective. To assess the performance of prognostic models in predicting mortality or clinical deterioration among patients with COVID-19, both hospitalized and non-hospitalized Methods. We conducted a systematic review of the literature until March 8, 2021. We included models for the prediction of mortality or clinical deterioration in COVID-19 with external validation. We used the Prediction model Risk Of Bias ASsessment Tool (PROBAST) and the GRADEpro Guideline Development Tool (GDT) to assess the evidence obtained. Results. We reviewed 33 cohort studies. Two studies had a low risk of bias, four unclear risks, and 27 with a high risk of bias due to participant selection and analysis. For the outcome of mortality, the QCOVID model had excellent prediction with high certainty of evidence but was specific for use in England. The COVID Outcome Prediction in the Emergency Department (COPE) model, the 4C Mortality Score, the Age, BUN, number of comorbidities, CRP, SpO2/FiO2 ratio, platelet count, heart rate (ABC2-SPH) risk score, the Confusion Urea Respiration Blood Pressure (CURB-65) severity score, the Rapid Emergency Medicine Score (REMS), and the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) score had fair to good prediction of death among inpatients, while the quick Sepsis-related Organ Failure Assessment (qSOFA) score had poor to fair prediction. The certainty of evidence for these models was very low to low. For the outcome of clinical deterioration, the 4C Deterioration Score had fair prediction, the National Early Warning Score 2 (NEWS2) score poor to good, and the Modified Early Warning Score (MEWS) had poor prediction. The certainty of evidence for these three models was also very low to low. None of these models had been validated in the Philippine setting. Conclusion. The QCOVID, COPE, ABC2-SPH, 4C, CURB-65, REMS, RISE-UP models for prediction of mortality and the 4C Deterioration and NEWS2 models for prediction of clinical deterioration are potentially useful but need to be validated among patients with COVID-19 of varying severity in the Philippine setting.

Ward post-operative care

2016 ◽  
Author(s):  
Ross Palmer ◽  
Alison Smith
Keyword(s):  
Early Warning ◽  
Early Recognition ◽  
Health Care Team ◽  
Early Warning Score ◽  
Breaking Bad ◽  
Patient Deterioration ◽  
Operative Care ◽  
Policies And Procedures ◽  
Recognition And Response ◽  
Operative Monitoring

Standardized, evidence-based post-operative policies and procedures ensure that safe and effective person-centred care is provided, which is aimed at reducing the likelihood of post-operative complications. Close physiological monitoring is imperative and should incorporate the use of an early warning score such as the National Early Warning Score (NEWS). This ensures early recognition and response to patient deterioration, which is quickly escalated to an appropriate member of the health-care team. This chapter provides an overview of oxygen therapy, wound drains, the removal of sutures and staples, post-operative monitoring, early warning scores, escalation, documentation standards, and breaking bad news.

scholarly journals Use of paediatric early warning scores in intermediate care units

2019 ◽  
pp. archdischild-2019-317055
Author(s):  
Marie Emilie Lampin ◽  
Alain Duhamel ◽  
Hélène Behal ◽  
Morgan Recher ◽  
Francis Leclerc ◽  
...  
Keyword(s):  
Early Warning ◽  
Emergency Departments ◽  
Repeated Measures ◽  
Medical Intervention ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Intermediate Care ◽  
Derivation Cohort ◽  
Early Warning Scores

ObjectivePaediatric early warning scores (EWS) were developed to detect deterioration in paediatric wards or emergency departments. The aim of this study was to assess the relationship between three paediatric EWS and clinical deterioration detected by the nurse in paediatric intermediate care units (PImCU).MethodsThis was a prospective, observational, multicentre study at seven French regional hospitals that included all children <18 years of age. Clinical parameters included in three EWS (Paediatric Advanced Warning Score, Paediatric Early Warning Score and Bedside Paediatric Early Warning System) were prospectively recorded every 8 hours or in case of deterioration. The outcome was a call to physician by the nurse when a clinical deterioration was observed. The cohort was divided into derivation and validation cohorts. An updated methodology for repeated measures was used and discrimination was estimated by the area under the receiver-operating curve.ResultsA total of 2636 children were included for 14 708 observations to compute a posteriori the EWS. The discrimination of the three EWS for predicting calls to physicians by nurses was good (range: 0.87–0.91) for the derivation cohort and moderate (range: 0.71–0.76) for the validation cohort. Equations for probability thresholds of calls to physicians, taking into account the time t, the score at time t and the score at admission, are available.ConclusionThese three EWS developed for children in paediatric wards or emergency departments can be used in PImCU to detect a clinical deterioration and predict the need for medical intervention.

scholarly journals Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis (Preprint)

2020 ◽  
Author(s):  
Rebecca L Kowalski ◽  
Laura Lee ◽  
Michael C Spaeder ◽  
J Randall Moorman ◽  
Jessica Keim-Malpass
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Early Warning ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Transfer Event ◽  
Patients At Risk

BACKGROUND Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. OBJECTIVE The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. METHODS We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. RESULTS During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. CONCLUSIONS This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

scholarly journals IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA

2020 ◽  
Author(s):  
Enoch J Abbey ◽  
Jennifer S. Mammen ◽  
Samara E. Soghoian ◽  
Maureen Cadorette ◽  
Promise Ariyo
Keyword(s):  
Early Warning ◽  
Roc Curve ◽  
Predictive Accuracy ◽  
Early Recognition ◽  
Vital Signs ◽  
Objective Measure ◽  
Predictive Ability ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
African Countries

ABSTRACT BACKGROUND The modified early warning score (MEWS) is an objective measure of illness severity that promotes early recognition of clinical deterioration in critically ill patients. Its primary use is to; facilitate faster intervention or increase the level of care. Despite, its adoption in some African countries, MEWS is not standard of care in Ghana. We assessed the validity of MEWS as a predictor of mortality, among medically ill inpatients at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We sought to identify the predictive ability of MEWS in detecting clinical deterioration among medical in-patients and its comparability to the routinely measured vital signs. METHOD This was a retrospective study of medical inpatients, aged >=13 years and admitted at KBTH from January 2017 to March 2019. Vital signs at 48 hours after admission were coded using MEWS criteria, to obtain a limited MEWS score (LMEWS) and the level of consciousness imputed to obtain a full MEWS score (MEWS). A predictive model comparing mortality among patients with significant MEWS (L/MEWS >=4) and non-significant MEWS (L/MEWS <4) scores was designed using multiple logistic regression. Internally validated for predictive accuracy, using the Receiver Operating Characteristic (ROC) curve. RESULTS 112 patients were included in the study. The adjusted odds of death comparing patients with a significant MEWS to patients with non-significant MEWS was 6.33(95% CI 1.96 to 20.48). Similarly, the adjusted odds of death comparing patients with significant versus non-significant LMEWS was 8.22(95% CI 2.45 to 27.56). The ROC curve for each analysis had a C static of 0.83 and 0.84 respectively. CONCLUSION LMEWS is a good predictor of mortality and comparable to MEWS. Adoption of LMEWS can identify medical in-patients at risk of deterioration and death.

scholarly journals Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department

2021 ◽  
Vol 8 (6) ◽  
pp. 211-215
Author(s):  
Rasikapriya Duraisamy ◽  
Jagadeesh Vanaja ◽  
Karuppiah Pandi Ayyappa Samy ◽  
Banupriya Balasubramaniam ◽  
Soundararajan Palanisamy
Keyword(s):  
Emergency Department ◽  
Early Warning ◽  
Clinical Deterioration ◽  
Early Warning Score

scholarly journals Development and validation of an early warning score (EWAS) for predicting clinical deterioration in patients with coronavirus disease 2019

2020 ◽  
Author(s):  
Yabing Guo ◽  
Yingxia Liu ◽  
Jiatao Lu ◽  
Rong Fan ◽  
Fuchun Zhang ◽  
...  
Keyword(s):  
High Risk ◽  
Early Warning ◽  
Validation Cohort ◽  
Risk Groups ◽  
Incidence Rates ◽  
Clinical Deterioration ◽  
System Capacity ◽  
Early Warning Score ◽  
Multicenter Cohort Study ◽  
Endemic Areas

AbstractBackgroundSince the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients.MethodsIn this retrospective multicenter cohort study, we included 1138 mild to moderate COVID-19 patients admitted to 33 hospitals in Guangdong Province from December 27, 2019 to March 4, 2020 (N =818; training cohort), as well as two hospitals in Hubei Province from January 21 to February 22, 2020 (N =320; validation cohort) in the analysis.ResultsThe 14-day cumulative incidences of clinical deterioration were 7.9% and 12.1% in the training and validation cohorts, respectively. An Early WArning Score (EWAS) (ranging from 0 to 4.5), comprising of age, underlying chronic disease, neutrophil to lymphocyte ratio, C-reactive protein, and D-dimer levels, was developed (AUROC: 0.857). By applying the EWAS, patients were categorized into low-, medium-, and high risk groups (cut-off values: two and three). The 14-day cumulative incidence of clinical deterioration in the low-risk group was 1.8%, which was significantly lower than the incidence rates in the medium-(14.4%) and high-risk (40.9%) groups (P <.001). The predictability of EWAS was similar in the validation cohort (AUROC =0.781), patients in the low-, medium-, and high-risk groups had 14-day cumulative incidences of 2.6%, 10.0%, and 25.7%, respectively (P <.001).ConclusionThe EWAS, which is based on five common parameters, can predict COVID-19-related clinical deterioration and may be a useful tool for a rapid triage and establishing a COVID-19 hierarchical management system that will greatly focus clinical management and medical resources to reduce mortality in highly endemic areas.

scholarly journals Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

10.2196/25991 ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. e25991
Author(s):  
Rebecca L Kowalski ◽  
Laura Lee ◽  
Michael C Spaeder ◽  
J Randall Moorman ◽  
Jessica Keim-Malpass
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Early Warning ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Transfer Event ◽  
Patients At Risk

Background Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

Sign in / Sign up

Export Citation Format

Share Document