Development of a Pediatric Early Warning System Using Data-Driven Vital Signs

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 256A-256A
Author(s):  
Catherine Ross ◽  
Iliana Harrysson ◽  
Lynda Knight ◽  
Veena Goel ◽  
Sarah Poole ◽  
...  
2020 ◽  
Vol 2 (2) ◽  
pp. 135
Author(s):  
Junaedi Yunding ◽  
Masyita Haerianti ◽  
Evidamayanti Evidamayanti ◽  
Evawaty Evawaty ◽  
Indrawati Indrawati

AbstractSevere adverse events such as cardiac arrest and death are often marked by abnormal vital signs a few hours before the event. Majene Regional General Hospital is the only hospital in the Majene Regency and is a reference center for all puskesmas in the Majene and surrounding districts. As a health service institution that organizes health services, it is closely related to the responsibility of providing emergency services. The Nurse Early Warning System (NEWS) is a development in emergency services for patients treated in hospitals, which serves as an early detection tool so that if there is a decrease in the patient's condition it can be known earlier can be handled more quickly. The purpose of this activity is to increase the knowledge and skills of nurses in the application of the nurse early warning system (NEWS) in monitoring the condition of patients in the care room. The implementation method starts from identifying the problem, delivering material about NEWS, demonstrating the assessment of the patient's condition and the nurse's independent practice in using NEWS. The evaluation results of this activity are the increase in knowledge and skills of nurses using NEWS in monitoring the condition of patients in the care room.


2017 ◽  
Vol 18 (5) ◽  
pp. 469-476 ◽  
Author(s):  
Catherine E. Ross ◽  
Iliana J. Harrysson ◽  
Veena V. Goel ◽  
Erika J. Strandberg ◽  
Peiyi Kan ◽  
...  

2020 ◽  
Author(s):  
Solomon Seyoum ◽  
Boud Verbeiren ◽  
Patrick Willems

<p>Urban catchments are characterized by a high degree of imperviousness, as well as a highly modified landscape and interconnectedness. The hydrological response of such catchments is usually complex and fast and sensitive to precipitation variability at small scales. To properly model and understand urban hydrological responses, high-resolution precipitation measurements to capture spatiotemporal variability is crucial input.</p><p>In urban areas floods are among the most recurrent and costly disasters, as these areas are often densely populated and contain vital infrastructure. Runoff from impervious surfaces as a result of extreme rainfall leads to pluvial flooding if the system’s drainage capacity is exceeded. Due to the fast onset and localised nature of pluvial flooding, high-resolution models are needed to produce fast simulations of flood forecasts for early warning system development. Data-driven models for predictive modelling have been gaining popularity, due to the fact they require minimal inputs and have shorter processing time compared to other types of models.</p><p>Data-driven models to forecast peak flows in drainage channels of Brussels, Belgium are being developed at sub-catchment scale, as a proxy for pluvial flooding within the FloodCitiSense project. FloodCitiSense aims to develop an urban pluvial flood early warning service. The effectiveness of these models relies on the input data resolution among others. High-temporal resolution rainfall and runoff data from 13 rainfall and 13 flow gauging stations in Brussels for several years is collected (Open data from Flowbru.be) and the data-driven models for forecasting peak flows in drainage channels are build using the Random Forest classification model.</p><p>Optimal model inputs are determined to increase model performance, including rainfall and runoff information from the current time step, as well as additional information derived from previous time steps.</p><p>The additional inputs are determined by progressively including rainfall data from neighboring stations and runoff from previous time steps equivalent to the lag time equal to the forecasting horizon, in our case two hours. The data-driven model we develop has the form as shown in the following equation.</p><p><strong><em>Q<sub>t</sub> = f(Q<sub>t-lag</sub>, ∑RF<sub>i,j</sub>)  </em></strong><em>for <strong>i</strong> is the number of rainfall stations considered and <strong>j</strong> is the time  from <strong>t-lag</strong> to <strong>t</strong></em></p><p>Where <strong><em>Q<sub>t</sub>  </em></strong>is the flow at a flow station at time <strong><em>t</em></strong>, <strong><em>Q<sub>t-lag </sub></em></strong>is the lagged flow at the station and <strong><em>RF<sub>i,j </sub></em></strong>is the rainfall values for station <strong><em>i</em></strong> and time <strong><em>j</em></strong>.</p><p>For Brussels nine relevant sub-catchments were identified based on historical flood frequency for which we are building data-driven flood forecasting models. For each sub-catchment, RF models are being trained and tested. More than 200,000 data point were available for training and testing the models. For most of the flow stations the data-driven models perform well with R-squared values up to 0.84 for training and 0.6 for testing for a 2-hour forecast horizon. </p><p>To improve the reliability of the data-driven models, as next step, we are including radar rainfall data input, which has the ability to capture temporal and spatial variability of rainfall from localized convective storms to large scale moving storms.</p><p><strong>KEYWORDS</strong></p><p>Data driven models, FloodCitiSense, Flood Early Warning System, Urban pluvial flooding</p>


2018 ◽  
Vol 4 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Hannah L Nathan ◽  
Nicola Vousden ◽  
Elodie Lawley ◽  
Annemarie de Greeff ◽  
Natasha L Hezelgrave ◽  
...  

ObjectivesHaemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.MethodsThe development and the mixed-methods clinical evaluation of the VSA are described.ResultsPreliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women.ConclusionThe VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.


2017 ◽  
Vol 29 (4) ◽  
pp. 685-707 ◽  
Author(s):  
N. JOHNSON ◽  
A. HITCHMAN ◽  
D. PHAN ◽  
L. SMITH

In 2008, the Defense Advanced Research Project Agency commissioned a database known as the Integrated Crisis Early Warning System to serve as the foundation for models capable of detecting and predicting increases in political conflict worldwide. Such models, by signalling expected increases in political conflict, would help inform and prepare policymakers to react accordingly to conflict proliferation both domestically and internationally. Using data from the Integrated Crisis Early Warning System, we construct and test a self-exciting point process, or Hawkes process, model to describe and predict amounts of domestic, political conflict; we focus on Colombia and Venezuela as examples for this model. By comparing the accuracy of fitted models to the observed data, we find that we are able to closely describe occurrences of conflict in each country. Thus, using this model can allow policymakers to anticipate relative increases in the amount of domestic political conflict following major events.


2020 ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Luisa Ciofi Degli Atti ◽  
Immacolata Dall'oglio ◽  
...  

Abstract BackgroundClinical deterioration in children admitted to hospital wards often manifests through signs of increasing illness severity that may lead to unplanned Pediatric Intensive Care Unit admissions or cardiac arrest, if undetected. The Bedside Pediatric Early Warning System (BedsidePEWS) is a validated Canadian scoring system used at a large tertiary care children’ hospital to prevent critical illness and standardize the response to deteriorating children on the wards.MethodsA 6-month audit was performed to evaluate the use of the BedsidePEWS, escalation of patient observations, monitoring and medical reviews on the wards in 2018.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).ResultsA total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84% of the observed VS documentation events. Systolic blood Pressure was recorded in 79% and Temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).ConclusionsEscalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.


2020 ◽  
Vol 4 (1) ◽  
pp. 12
Author(s):  
Sekar Dwi Purnamasari ◽  
Denissa Faradita Aryani

<div class="WordSection1"><p class="AbstractContent"><strong>Objective:</strong> Early warning system (EWS) is a physiological scoring to observe the patient’s condition not only in hospital wards but also in Emergency Department (ED). At an overcrowded ER that have slow of patient flow, EWS is use as an early detection of patient’s deterioration by observing the vital signs. The purpose of this study was to identify the relationship between nurses’ knowledge of initial assessment and the application of EWS at emergency department.</p><p class="AbstractContent"><strong>Methods: </strong>This was a quantitative study that used descriptive correlative with cross-sectional design toward 70 emergency nurses.</p><p class="AbstractContent"><strong>Results:</strong> The result showed there was a relationship between nurses’ knowledge of initial assessment and the application of early warning system at emergency room <em>(p</em>=0 .001)<strong></strong></p><p><strong>Conclusion: </strong>The higher the level of nurses’ knowledge, their behavior is better. It is recommended to maintain the use of EWS in ED that already good through training regularly (re-certification).</p><p class="AbstractContent"><strong> </strong></p><div><p class="Keywords"><strong>Keywords: </strong>Early warning system; emergency department; initial assessment; nurses’ knowledge.</p></div></div>


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Ciofi Degli Atti ◽  
Immacolata Dall’Oglio ◽  
...  

Abstract Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.


Water ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1808 ◽  
Author(s):  
Alberto de la Fuente ◽  
Viviana Meruane ◽  
Carolina Meruane

The intensification of the hydrological cycle because of global warming raises concerns about future floods and their impact on large cities where exposure to these events has also increased. The development of adequate adaptation solutions such as early warning systems is crucial. Here, we used deep learning (DL) for weather-runoff forecasting in región Metropolitana of Chile, a large urban area in a valley at the foot of the Andes Mountains, with more than 7 million inhabitants. The final goal of this research is to develop an effective forecasting system to provide timely information and support in real-time decision making. For this purpose, we implemented a coupled model of a near-future global meteorological forecast with a short-range runoff forecasting system. Starting from a traditional hydrological conceptual model, we defined the hydro-meteorological and geomorphological variables that were used in the data-driven weather-runoff forecast models. The meteorological variables were obtained through statistical scaling of the Global Forecast System (GFS), thus enabling near-future prediction, and two data-driven approaches were implemented for predicting the entire hourly flow time-series in the near future (3 days), a simple Artificial Neural Networks (ANN) and a Deep Learning (DL) approach based on Long-Short Term Memory (LSTM) cells. We show that the coupling between meteorological forecasts and data-driven weather-runoff forecast models are able to satisfy two basic requirements that any early warning system should have: The forecast should be given in advance, and it should be accurate and reliable. In this context, DL significantly improves runoff forecast when compared with a traditional data-driven approach such as ANN, being accurate in predicting time-evolution of output variables, with an error of 5% for DL, measured in terms of the root mean square error (RMSE) for predicting the peak flow, compared to 15.5% error for ANN, which is adequate to warn communities at risk and initiate disaster response operations.


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