All Journals from Alan Murray
Abstract
Background: it is not known how best to respond to changes in the National Early Warning Score (NEWS) after hospital admission. This report manipulates and extrapolates previously published data on the trajectories of the abbreviated early warning score (AbEWS i.e. NEWS that does not include mental status).
Methods: trajectories of averaged AbEWS for patients for their first 5 days in hospital and their last 5 days in hospital were combined to obtain an approximation of what happens to the average patient while in hospital.
Results: the trajectories of patients admitted with a low score are different from those admitted with a high score. Patients should be observed for 12 to 24 hours before their outcome can be predicted. The score of most patients who die in hospital trends upward on the second or third day after admission. Patients admitted with a score of 0-2 who raise their score to >=3 have a ten-fold increase in-hospital mortality.
Conclusions: the trajectories of early warning scores after admission are of prognostic importance, and escalation protocols should relate changes in the score to its initial value on admission.
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Abstract
Background: Recently a very simple, easy to remember early warning score (EWS) dubbed TOTAL has been reported. The score was derived from 309 acutely ill medical patients admitted to a Malawian hospital and awards one point for Tachypnea >30 breaths per minute, one point for Oxygen saturation <90%, two points for a Temperature <35°C, one point for Altered mental status, and one point for Loss of independence as indicated by the inability to stand or walk without help. TOTAL has an area under the receiver operator characteristic curve (AUROC) for death within 72 hours of 78%. Methods: We compared the performance of the TOTAL score in 849 medical patients attending a resource poor hospital in Uganda and 2935 patients admitted to a small rural hospital in Ireland. Results: TOTAL’s AUROC for death within 24 hours was the same in both hospital populations: 85.1% (95% CI 78.6 – 91.6%) for Kitovu Hospital patients and 84.7% (95% CI 77.1 – 92.2%) for Nenagh Hospital patients. Conclusion: The discrimination of TOTAL is exactly the same in elderly Irish patients as it is in young African patients. The score is easy to remember, easy to calculate, and works over a broad range of patients.
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Abstract
Background: little is known about the changes and trends of individual vital signs during the course of acute illness in hospital.
Methods: the weighted points of the VitalPAC Early Warning Score (ViEWS) were assigned to each vital sign value measured on 44,531 acutely ill medical patients while they were hospitalized in the Thunder Bay Regional Health Sciences Centre, Ontario, Canada. These ViEWS weighted vital signs were averaged for every 24 hour period for five days after admission and five days before death or discharge and then combined to obtain an approximation of the trajectory of each vital sign while in hospital.
Results: compared with the other vital signs, the ViEWS weighted points for respiratory rate increase the most in patients who died in hospital and decrease the most in survivors. Combining respiratory rate with the weighted points for any of the other vital signs reduced rather than increased their monitoring performance.
Conclusion: trends in respiratory rate, measured by observation at the bedside and given a ViEWS weighting is the best predictor of clinical outcome; minor changes predicted clinical outcome several days in advance.
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