Early Deterioration Indicator: Data-driven approach to detecting deterioration in general ward

Ghosh, Erina; Eshelman, Larry J.; Yang, Lin; Carlson, Eric; Lord, Bill

doi:10.1016/j.resuscitation.2017.10.026

Cited by 34 publications

(26 citation statements)

References 14 publications

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“…Our results are consistent with those of previous studies [1, 15–20], where the combination of physiological and clinical data from the NEWS2 together with additional data at hospital level during triage in the ED improves the predictive capacity of the studied models.…”

Section: Discussionsupporting

confidence: 92%

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Emergency Medicine International

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Aim of the Study. To evaluate the ability of the prehospital National Early Warning Score 2 scale (NEWS2) to predict early mortality (within 48 hours) after the index event based on the triage priority assigned for any cause in the emergency department. Methods. This is a multicenter longitudinal observational cohort study on patients attending Advanced Life Support units and transferred to the emergency department of their reference hospital. We collected demographic, physiological, and clinical variables, main diagnosis, and hospital triage level as well as mortality. The main outcome variable was mortality from any cause within two days of the index event. Results. Between April 1 and November 30, 2018, a total of 1054 patients were included in our study. Early mortality within the first 48 hours after the index event affected 55 patients (5.2%), of which 23 cases (41.8%) had causes of cardiovascular origin. In the stratification by triage levels, the AUC of the NEWS2 obtained for short-term mortality varied between 0.77 (95% CI: 0.65-0.89) for level I and 0.94 (95% CI: 0.79-1) for level III. Conclusions. The Prehospital Emergency Medical Services should evaluate the implementation of the NEWS2 as a routine evaluation, which, together with the structured hospital triage system, effectively serves to predict early mortality and detect high-risk patients.

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Section: Discussionsupporting

confidence: 92%

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Emergency Medicine International

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“…With the decision tree, a rate of up to 18 scores 0, 19 to 20 scores 1, 21 to 25 scores 2, and 25 or more is scored at 3, thus fitting a gradual effect to the clinical respiratory rate measurements. Similarly, a logistic regression process can more readily classify poor outcome [15]. Simply put, converting a continuous measure (such as respiratory rate) into categories (such as a score) by using cut-off values is statistically inefficient [16].…”

Section: Discussionmentioning

confidence: 99%

Current clinical methods of measurement of respiratory rate give imprecise values

2020

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BackgroundRespiratory rate is a basic clinical measurement used for illness assessment. Errors in measuring respiratory rate are attributed to observer and equipment problems. Previous studies commonly report rate differences ranging from 2 to 6 breaths·min−1 between observers.MethodsTo study why repeated observations should vary so much, we conducted a virtual experiment, using continuous recordings of breathing from acutely ill patients. These records allowed each breathing cycle to be precisely timed. We made repeated random measures of respiratory rate using different sample durations of 30, 60 and 120 s. We express the variation in these repeated rate measurements for the different sample durations as the interquartile range of the values obtained for each subject. We predicted what values would be found if a single measure, taken from any patient, were repeated and inspected boundary values of 12, 20 or 25 breaths·min−1, used by the UK National Early Warning Score, for possible mis-scoring.ResultsWhen the sample duration was nominally 30 s, the mean interquartile range of repeated estimates was 3.4 breaths·min−1. For the 60 s samples, the mean interquartile range was 3 breaths·min−1, and for the 120 s samples it was 2.5 breaths·min−1. Thus, repeat clinical counts of respiratory rate often differ by >3 breaths·min−1. For 30 s samples, up to 40% of National Early Warning Scores could be misclassified.ConclusionsEarly warning scores will be unreliable when short sample durations are used to measure respiratory rate. Precision improves with longer sample duration, but this may be impractical unless better measurement methods are used.

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“…Vital signs were then assigned weights for NEWS and NEWS2 scores (see appendix A1). The sum of the weights (aggregate 22,24 , and in line with previous vital-signs-based EWS research [25][26][27][28] , each vital sign set was analysed as independently associated with the outcome.…”

Section: Predictorsmentioning

confidence: 99%

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

et al. 2019

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Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. Methods:We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation.Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic.Results: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination.Conclusions: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO 2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

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Early Deterioration Indicator: Data-driven approach to detecting deterioration in general ward

Cited by 34 publications

References 14 publications

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality

Current clinical methods of measurement of respiratory rate give imprecise values

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

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