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Early AND warning AND score

A R Corfield, D Silcock, L Clerihew, P Kelly, E Stewart, H Staines, K D Rooney
INTRODUCTION: Physiological deterioration often precedes clinical deterioration as patients develop critical illness. Use of a specific Paediatric Early Warning Score (PEWS), based on basic physiological measurements, may help identify children prior to their clinical deterioration. NHS Scotland has adopted a single national PEWS - PEWS (Scotland). We aim to look at the utility of PEWS (Scotland) in unselected paediatric ambulance patients. METHODS: We performed a retrospective cohort of all ambulance patients aged under 16 years conveyed to hospital in Scotland between 2011 and 2015...
October 15, 2018: Resuscitation
Su-Han Chang, Chiao-Hsuan Hsieh, Yi-Ming Weng, Ming-Shun Hsieh, Zhong Ning Leonard Goh, Hsien-Yi Chen, Tung Chang, Chip-Jin Ng, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chen-June Seak
Background: Renal abscess is a relatively uncommon yet debilitating and potentially fatal disease. There is no clearly defined, objective risk stratification tool available for emergency physicians' and surgeons' use in the emergency department (ED) to quickly determine the appropriate management strategy for these patients, despite early intervention having a beneficial impact on survival outcomes. Objective: This case control study evaluates the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting risk of mortality in ED adult patients with renal abscess...
2018: BioMed Research International
Pernille Brok Nielsen, Niels Engholm Pedersen, Martin Schultz, Christian Sahlholt Meyhoff, Anne Marie Kodal, Gitte Bunkenborg, Anne Lippert, Ove Andersen, Lars Simon Rasmussen, Kasper Kermark Iversen
Early Warning Score (EWS) are used extensively to identify patients at risk of deterioration during hospital admission. The validation of EWS has primarily focused on investigating predictive validity, i.e. the association between EWS and severe adverse events. Few studies have tested, whether EWS work in the clinical setting, and if it prevents severe adverse events from occurring. Many of these studies have methodological limitations, and their clinical relevance could be questioned. Currently, there is limited evidence to support, that the implementation of EWS reduces the occurrence of severe adverse events...
October 15, 2018: Ugeskrift for Laeger
Nicholas Ballester, Pratik J Parikh, Michael Donlin, Elizabeth K May, Steven R Simon
OBJECTIVES: To develop an early warning discharge disposition prediction tool based on clinical and health services factors for hospitalized patients. Recent study results suggest that early prediction of discharge disposition (ie, whether patients can return home or require placement in a facility) can improve care coordination, expedite care planning, and reduce length of stay. STUDY DESIGN:  Retrospective analysis of inpatient data; development of multiple logistic regression model and an easy-to-use score...
October 1, 2018: American Journal of Managed Care
Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Jianxia Sun, Alan J Girling, Cassie Aldridge, Felicity Evison, Chris Beet, Amunpreet Boyal, Gavin Rudge, Richard J Lilford, Julian Bion
OBJECTIVE: To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness. DESIGN: Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England. OUTCOME MEASURES: 30-day postadmission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score (NEWS)), routes of admission to hospital, transfer to the intensive care unit (ICU) and demographics...
October 9, 2018: BMJ Quality & Safety
Bin Li, Shengfan Zhang, Stephen Hoover, Ryan Arnold, Muge Capan
While physiological warning signs prior to deterioration events during hospitalization have been widely studied, evaluating clinical interventions, such as Rapid Response Team (RRT) activations, based on scoring systems remains an understudied area. Simulation of physiological deterioration patterns represented by scoring systems can facilitate testing different RRT policies without disturbing care processes. Christiana Care Early Warning System (CEWS) is a scoring system developed at the study hospital to detect the physiological warning signs and inform RRT activations...
October 4, 2018: IEEE Journal of Biomedical and Health Informatics
Luke E Hodgson, Jo Congleton, Richard Venn, Lui G Forni, Paul J Roderick
The Royal College of Physicians (RCP) recently published the National Early Warning Score 2 (NEWS2), aiming to improve safety for patients with hypercapnic respiratory failure by suggesting a separate oxygen saturation (SpO2 ) parameter scoring system for such patients. A previously published study of patients (n=2,361 admissions) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) demonstrated alternative scoring systems at admission did not outperform the original NEWS. Applying NEWS2 SpO2 parameters to this previously described cohort would have resulted in 44% (n=27/62) of patients who scored ≥7 points on the original NEWS and subsequently died being placed in a lower call-out threshold...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Marco A F Pimentel, Oliver C Redfern, Stephen Gerry, Gary S Collins, James Malycha, David Prytherch, Paul E Schmidt, Gary B Smith, Peter J Watkinson
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)...
October 1, 2018: Resuscitation
Peter J Lillitos, Mark D Lyttle, Damian Roland, Colin Ve Powell, Julian Sandell, Andrew G Rowland, Susan M Chapman, Ian K Maconochie
BACKGROUND: Clarifying whether paediatric early warning scores (PEWS) accurately predict significant illness is a research priority for UK and Ireland paediatric emergency medicine (EM). However, a standardised list of significant conditions to benchmark these scores does not exist. OBJECTIVES: To establish standardised significant illness endpoints for use in determining the performance accuracy of PEWS and safety systems in emergency departments (ED), using a consensus of expert opinion in the UK and Ireland...
October 3, 2018: Emergency Medicine Journal: EMJ
Romesh Jayasundera, Mark Neilly, Toby O Smith, Phyo Kyaw Myint
BACKGROUND: Early warning scores (EWSs) are used to identify deteriorating patients for appropriate interventions. We performed a systematic review to examine the usefulness of EWSs in predicting inpatient mortality and morbidity (transfer to higher-level care and length of hospital stay) in older people admitted to acute medical units with sepsis, acute cardiovascular events, or pneumonia. METHODS: A systematic review of published and unpublished databases was conducted...
September 28, 2018: Journal of Clinical Medicine
Oliver C Redfern, Marco A F Pimentel, David Prytherch, Paul Meredith, David A Clifton, Lionel Tarassenko, Gary B Smith, Peter J Watkinson
AIM: The National Early Warning System (NEWS) is based on vital signs; the Laboratory Decision Tree Early Warning Score (LDT-EWS) on laboratory test results. We aimed to develop and validate a new EWS (the LDTEWS:NEWS risk index) by combining the two and evaluating the discrimination of the primary outcome of unanticipated intensive care unit (ICU) admission or in-hospital mortality, within 24 h. METHODS: We studied emergency medical admissions, aged 16 years or over, admitted to Oxford University Hospitals (OUH) and Portsmouth Hospitals (PH)...
September 22, 2018: Resuscitation
Line J H Rasmussen, Steen Ladelund, Thomas H Haupt, Gertrude E Ellekilde, Jesper Eugen-Olsen, Ove Andersen
OBJECTIVES: Soluble urokinase plasminogen activator receptor is a prognostic biomarker associated with critical illness, disease progression, and risk of mortality. We aimed to evaluate whether soluble urokinase plasminogen activator receptor adds prognostic value to a vital sign-based score for clinical monitoring of patient risk (National Early Warning Score) in acute medical patients. DESIGN: Registry-based observational cohort study of consecutively admitted acute medical patients...
September 21, 2018: Critical Care Medicine
Armando D Bedoya, Meredith E Clement, Matthew Phelan, Rebecca C Steorts, Cara O'Brien, Benjamin A Goldstein
OBJECTIVES: Previous studies have looked at National Early Warning Score performance in predicting in-hospital deterioration and death, but data are lacking with respect to patient outcomes following implementation of National Early Warning Score. We sought to determine the effectiveness of National Early Warning Score implementation on predicting and preventing patient deterioration in a clinical setting. DESIGN: Retrospective cohort study. SETTING: Tertiary care academic facility and a community hospital...
September 21, 2018: Critical Care Medicine
Kimberly C Claeys, Evan J Zasowski, Abdalhamid M Lagnf, Noor Sabagha, Donald P Levine, Susan L Davis, Michael J Rybak
INTRODUCTION: Acute bacterial skin and skin structure infections (ABSSSIs) represent a large burden to the US healthcare system. There is little evidence-based guidance regarding the appropriate level of care for ABSSSIs. This study aimed to develop a prediction model and risk-scoring tool to determine appropriate levels of care. METHODS: This was a single-center observational cohort study of adult patients treated for ABSSSIs from 2012 to 2015 at the Detroit Medical Center...
September 22, 2018: Infectious Diseases and Therapy
Christopher K Page-Goertz, Mahua Dasgupta, Raymond G Hoffmann, Christopher Parshuram, Michael L Forbes, Michael T Meyer
BACKGROUND: The Bedside Pediatric Early Warning System score is a validated measure of severity of illness in acute care inpatient settings. Its potential as a remote assessment tool for interfacility transport has not been evaluated. We hypothesized that the Bedside Pediatric Early Warning System score was associated with need for intervention during the peritransport period and patient disposition. METHODS: We retrospectively evaluated children transported by a regional pediatric team during a 6-month period...
September 18, 2018: Pediatric Critical Care Medicine
Rong Chen, Yongchao He, Fang Zhang, Yinhao Lu, Yi He
OBJECTIVE: To establish an emergency response capability assessment indexes for disease control and prevention institutions. METHODS: Health emergency response capability assessment indexes of Shanghai Centers for Disease Control and Prevention(CDCs) was drafted based upon documentary analysis, expert consultation and focus group discussion according to duties and features of emergency work of CDCs. The assessment indexes were determined by applying Delphi method (18 experts), and the weights of indexes were determined using analytic hierarchy process and proportional distribution method...
May 25, 2018: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Manuela Carugati, Helen L Zhang, Kajiru G Kilonzo, Michael J Maze, Venance P Maro, Matthew P Rubach, John A Crump
Febrile illnesses are a major cause of mortality in sub-Saharan Africa. Early identification of patients at increased risk of death may avert adverse outcomes. We aimed to independently evaluate the performance of the Modified Early Warning Score, quick Sequential Organ Failure Assessment (qSOFA) score, and Integrated Management of Adolescent and Adult Illness (IMAI) emergency signs and severity criteria to predict in-hospital mortality among a prospective cohort of febrile patients in Tanzania. We evaluated 419 patients aged ≥ 10 years in the period 2007-2008...
September 17, 2018: American Journal of Tropical Medicine and Hygiene
Konstantinos Gerasimidis, Shamsi Milani, Andrew Tester, Orla Purcell, Catriona Woodley, Melina Tsiountsioura, Alexandra Koulieri, Ourania Zerva, Konstantina Loizou, Mandana Rafeey, Meropi Kontogianni, Charlotte Wright
BACKGROUND & AIMS: Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input. METHODS: Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece...
September 5, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
V L Keevil, G J Martin, R Biram, S Wallis, R Romero-Ortuno
BACKGROUND: Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. METHODS: This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes...
September 2018: Journal of the Royal College of Physicians of Edinburgh
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