Use of an admission early warning score to predict patient morbidity and mortality and treatment success

Groarke, John D.; Gallagher, Joe; Stack, Janice; Aftab, AR; Dwyer, Cindy; McGovern, Rory; Courtney, Garry

doi:10.1136/emj.2007.051425

Cited by 97 publications

(82 citation statements)

References 9 publications

(8 reference statements)

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“….39); however, the sensitivity for EWS>5 was only 0.172. 16 The observed low sensitivities of early warning scores in the ED for detecting both adults and children at high risk for rapid clinical deterioration emphasize the need for developing more sensitive scoring systems so that a larger proportion of patients at high risk for rapid clinical deterioration may be detected in the ED. …”

Section: Discussionmentioning

confidence: 99%

Identifying High-Risk Children in the Emergency Department

Nielsen

Migita

Batra

et al. 2016

J Intensive Care Med

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Identifying high risk children in the emergency department Katie R. Nielsen Chair of the Supervisory Committee:Noel S. Weiss, MD, DrPH EpidemiologyObjectives: Early warning scores reduce the occurrence of in-hospital cardiac arrest by identifying high-risk hospitalized patients prior to clinical deterioration. However, the ability of early warning scores to identify high-risk pediatric patients in the emergency department (ED)has not been evaluated. We aimed to determine the association between the modified pediatric early warning score (MPEWS) in the ED and clinical deterioration that necessitated subsequent inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission.Methods: This is a case-control study of 597 pediatric patients admitted from the ED to the inpatient ward at Seattle Children's Hospital between July 1, 2010 and December 31, 2011.Cases were admitted to the inpatient ward and transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward at 24 hours. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi square analysis.Results: There were no differences in demographic characteristics between cases and controls.Children with an MPEWS of 7 or greater in the ED were relatively more likely to be transferred to the PICU within 24 hours (OR 8.36, 95% CI 2.98, 22.08). However, an MPEWS threshold of 7 yielded a sensitivity of only 18.0% and a specificity of 97.4%.Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS of 7 or higher is not sufficient to identify more than a small proportion of children with subsequent clinical deterioration.

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Section: Discussionmentioning

confidence: 99%

Identifying High-Risk Children in the Emergency Department

Nielsen

Migita

Batra

et al. 2016

J Intensive Care Med

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“…Several studies have shown that hospital mortality can be predicted on the basis of illness severity scores calculated at the time of admission, either in the emergency department, 18,19 an assessment unit 20,21 or a medical ward. 22 None of these studies looked at whether the average early warning scores varied according to time or day of admission; although such scores are somewhat blunt tools, this analysis may be a useful next step to help our understanding of the variation in mortality we have observed.…”

Section: Patient and Pre-hospital Factorsmentioning

confidence: 99%

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Maggs¹,

Mallet²

2010

JRCPE

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Mortality among emergency medical admissions to hospital is higher for admissions at the weekend than on weekdays; this also holds true for certain specific conditions. However, it is unknown whether that effect is limited to weekends. This study calculated mortality in emergency medical admissions for each day of the week, and compared mortality at weekends with weekdays, at nights with days, and in all out-of-hours periods with in-hours in a UK district general hospital. Total mortality was increased for admissions on Mondays, at night, and in all out-of-hours periods; late in-hospital mortality (after seven days) remained increased when the initial admission occurred on Mondays, at night or out of hours. It is likely that illness severity as well as resource and organisational factors are involved.

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“…21,22 In addition to specific organizational pathways, that have to be built together with ED units for diseases at higher risk of acute organ failure as indicated above, it is therefore essential, at the admission in the ward and throughout the course of hospital stay, a widely accepted, easily reproducible risk stratification system (triage) of the patients, to provide the better adequate care related to their actual needs. [23][24][25][26] For this purpose the IM adapted mEWS proved to be a simple and effective tool. 27,28 We share the opinion by Chesi and Nardi, 24 for which the stratification of patients for different clinical risk in IM should not be based only on vital parameters, since there are medical conditions, although with lower scores at admission, that are at higher risk of organ failure or sudden worsening, requiring, regardless of the score at admission, a close clinical monitoring.…”

Section: Discussionmentioning

confidence: 99%

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

et al. 2015

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The hospital internal medicine (IM) needs to adapt to the socio-demographic changes occurred during the last thirty years: patients currently show an increased overall complexity owing to the increase in the average age of the patients admitted, to more several and severe comorbidities, and a higher concentration in our wards of most severe cases. Our departments have to change in order to pursue a more efficient organization and to offer care to users modulated according to their needs and conditions. The Intensity of Care in Internal Medicine Group of the Federation of Associations of Hospital Doctors on Internal Medicine - Lazio carried out a population-based study in eight Internal Medicine wards of the region with the aim of characterizing the patients there admitted, using the modified early warning score (mEWS), monitoring and evaluating the outcomes of hospitalization. This has allowed us to determine the cut-off of the score indicating a greater statistical probability of a fatal outcome corresponding to 3, contrary to what originally reported by Subbe <em>et al.</em> in 2001. According to our results into the Departments of IM should be provided an area of high care, where monitor and stabilize the patients admitted with a mEWS score ≥3, before transferring them to the wards of lower intensity of care. This organizational model of the high care of medical patients has the benefit of offer the technical and professional assistance appropriate to the level of clinical risk, with more intensive care to more critical stages of illness.

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Use of an admission early warning score to predict patient morbidity and mortality and treatment success

Cited by 97 publications

References 9 publications

Identifying High-Risk Children in the Emergency Department

Identifying High-Risk Children in the Emergency Department

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

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