News, Heart Rate Variability and Early Warning Score for Oxygen Therapy (EWS.O2): Predictors of Poor Outcomes in ICU Patient Under Spontaneous Ventilation?

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.

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Heart Rate Variability Threshold Values for Early-Warning Nonfunctional Overreaching in Elite Female Wrestlers

The Journal of Strength and Conditioning Research ◽

10.1519/jsc.0b013e31826caef8 ◽

2013 ◽

Vol 27 (6) ◽

pp. 1511-1519 ◽

Cited By ~ 19

Author(s):

Ye Tian ◽

Zi-hong He ◽

Jie-xiu Zhao ◽

Da-lang Tao ◽

Kui-yun Xu ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Early Warning ◽

Threshold Values

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Evaluation of the performance of the modified early warning score in a Brazilian public hospital

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2017-0537 ◽

2019 ◽

Vol 72 (6) ◽

pp. 1428-1434 ◽

Cited By ~ 1

Author(s):

Sayane Marlla Silva Leite Montenegro ◽

Carlos Henrique Miranda

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Intensive Care ◽

Early Warning ◽

Public Hospital ◽

Cardiopulmonary Arrest ◽

Early Warning Score ◽

Level Of Consciousness ◽

Nursing Ward ◽

Predictive Study

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.

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National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India

PLoS ONE ◽

10.1371/journal.pone.0261376 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261376

Author(s):

Pugazhvannan CR ◽

Ilavarasi Vanidassane ◽

Dhivya Pownraj ◽

Ravichandran Kandasamy ◽

Aneesh Basheer

Keyword(s):

Risk Stratification ◽

Early Warning ◽

Area Under The Curve ◽

Clinical Score ◽

Supplemental Oxygen ◽

Early Warning Score ◽

National Early Warning Score ◽

Poor Outcomes ◽

Indian Setting ◽

Sensitivity Specificity

Background While several parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline might help early risk stratification. We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19. Methods A prospective study was conducted on 399 hospitalised adults with confirmed SARS-CoV-2 infection between August and December 2020. Baseline NEWS2 score was determined. Primary outcome was poor outcomes defined as need for mechanical ventilation or death within 28 days. The sensitivity, specificity and Area under the curve were determined for NEWS2 scores of 5 and 6. Results Mean age of patients was 55.5 ± 14.8 years and 275 of 399 (68.9%) were male. Overall mortality was 3.8% and 7.5% had poor outcomes. Median (interquartile range) NEWS2 score at admission was 2 (0–6). Sensitivity and specificity of NEWS 2 of 5 or more in predicting poor outcomes was 93.3% (95% CI: 76.5–98.8) and 70.7% (95% CI: 65.7–75.3) respectively [area under curve 0.88 (95% CI: 0.847–0.927)]. Age, baseline pulse rate, baseline oxygen saturation, need for supplemental oxygen and ARDS on chest X ray were independently associated with poor outcomes. Conclusions NEWS2 score of 5 or more at admission predicts poor outcomes in patients with COVID-19 with good sensitivity and can easily be applied for risk stratification at baseline. Further studies are needed in the Indian setting to validate this simple score and recommend widespread use.

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Bedside vital parameters that indicate early deterioration

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-10-2017-0206 ◽

2019 ◽

Vol 32 (1) ◽

pp. 262-272 ◽

Cited By ~ 3

Author(s):

Gitte Bunkenborg ◽

Ingrid Poulsen ◽

Karin Samuelson ◽

Steen Ladelund ◽

Jonas Akeson

Keyword(s):

Heart Rate ◽

Early Warning ◽

Cox Regression ◽

University Hospital ◽

Early Warning Score ◽

Content Type ◽

Vital Parameter ◽

Parameter Values ◽

Level 2 ◽

Vital Parameters

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.

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Use of the National Early Warning Score in community nursing: a scoping review

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.8.396 ◽

2021 ◽

Vol 26 (8) ◽

pp. 396-404

Author(s):

Anne-Marie Phillips

Keyword(s):

Scoping Review ◽

Early Warning ◽

Early Warning Score ◽

Current Evidence ◽

Community Nursing ◽

Community Settings ◽

National Early Warning Score ◽

Barriers To Use ◽

Poor Outcomes ◽

The Uk

People in the UK are living longer and with multi-morbidities, increasing the size, complexity and acuity of Community Nursing caseloads. Nurses visiting infrequently and inconsistently on a task-focused basis need an objective method by which to identify / quantify physical deterioration for early treatment avoiding crisis and hospital admission. The National Early Warning Score (NEWS), is the most recognised tool for identification of deterioration in acute settings but is not validated for community use. Using published frameworks for scoping review and evaluation, this study aims to explore the current evidence for use of NEWS in community settings. Although there is work to be done, particularly in terms of frequency of scoring and response, this study identifies benefits in communication and prioritisation of care as well as sensitivity, particularly in predicting poor outcomes. The identified barriers to use include integration into practice and perceived dissonance with clinical judgement.

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Protocol of the sepsivit study: a prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital

BMJ Open ◽

10.1136/bmjopen-2017-018259 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018259 ◽

Cited By ~ 4

Author(s):

Vincent M Quinten ◽

Matijs van Meurs ◽

Maurits H Renes ◽

Jack J M Ligtenberg ◽

Jan C ter Maaten

Keyword(s):

Emergency Department ◽

Heart Rate ◽

Heart Rate Variability ◽

Observational Study ◽

Respiratory Rate ◽

Early Warning ◽

Prospective Observational Study ◽

Medical Center ◽

Peripheral Oxygen Saturation ◽

Suspected Infection

IntroductionOne in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an early warning for deterioration in patients presenting with suspected infection or sepsis to the emergency department (ED).Methods and analysisThe protocol of a prospective observational study in the ED. We will include 171 adult medical patients presenting with suspected infection or sepsis and at least two systemic inflammatory response syndrome criteria. Patients with known pregnancy, cardiac transplantation or not admitted to our hospital are excluded.High sample frequency ECG signals (500 Hz), respiratory rate, blood pressure and peripheral oxygen saturation will be recorded continuously during the first 48 hours of hospitalisation using a bedside patient monitor (Philips IntelliVue MP70). Primary endpoint is patient deterioration, defined as the development of organ dysfunction, unplanned intensive care unit admission or in-hospital mortality. The ECG data will be used for offline HRV analysis. We will compare the HRV between two groups (deterioration/no deterioration) and analyse whether HRV provides an early warning for deterioration. Furthermore, we will create a multivariate predictive model for deterioration based on heart rate, respiratory rate and HRV. As planned secondary analyses, we (1) perform a subgroup analysis for patients with pneumosepsis and urosepsis and (2) determine whether HRV using lower sample frequencies (1 Hz or less) suffices to predict deterioration.Ethics and disseminationThe Institutional Review Board of the University Medical Center Groningen granted a waiver for the study (METc 2015/164). Results will be disseminated through international peer-reviewed publications and conference presentations. A lay summary of the results will be provided to the study participants.Trial registration numberNTR6168; Pre-results.

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