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.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]
References
- Bleyer AJ, Vidya S, Russell GB, et al. Longitudinal analysis of one million vital signs in patients in an academic medical center Resuscitation. 2011; 82: 1387–92.
- Murray A, Kellett J, Huang W, et al. Trajectories of the averaged abbreviated VitalpacTM early warning score (AbEWS) and clinical course of 44,531 consecutive admissions hospitalized for acute medical illness. Resuscitation 2014; 85: 544–8.
- Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation 2010; 81: 932–7.
- Cretikos MA, Bellomo R, Hillman K, et al. Respiratory rate: the neglected vital sign. Med J Aust 2008; 188: 657–9.
- Lovett PB, Buchwald JM, Sturmann K, et al. The Vexatious Vital: Neither Clinical Measurements by Nurses Nor an Electronic Monitor Provides Accurate Measurements of Respiratory Rate in Triage Ann Emerg Med. 2005; 45: 68–76.
- Kause J, Smith G, Prytherch D, et al. For the Intensive Care Society (UK) & Australian and New Zealand Intensive Care Society Clinical Trials Group ACADEMIA Study investigators A comparison of Antecedents to Cardiac Arrests, Deaths and Emergency Intensive care Admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA study. Resuscitation 2004; 62: 275–82.
- Brown H, Terrence J, Vasquez P, et al. Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med. 2014; 127: 226–32.
- Taenzer AH, Pyke JB, McGrath SP. A review of current and emerging approaches to address failure-to-rescue. Anesthesiology 2011; 115: 421–31.
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
