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Early warning score

Dai Wang, Srihari Gopal, Susan Baker, Vaibhav A Narayan
Effective early detection of impending relapse may offer opportunities for early interventions to prevent full relapse in schizophrenia patients. Previously reported early warning signs were not consistently validated by prospective studies. It remains unclear which symptoms are most predictive of relapse. To prioritize the symptoms to be captured by periodic self-report in technology-enabled remote assessment solutions for monitoring symptoms and detecting relapse early, we analyzed data from three relapse-prevention studies to identify individual items of the Positive and Negative Syndrome Scale (PANSS) that changed the most prior to relapse and to understand exactly when these symptoms manifested...
June 20, 2018: NPJ Schizophrenia
Valerie Danesh, Terry L Jones
No abstract text is available yet for this article.
July 2018: Critical Care Medicine
Blair L Bigham, Teresa Chan, Steven Skitch, Alison Fox-Robichaud
CLINICIAN'S CAPSULE What is known about the topic? Early warning scores reduce morbidity and mortality by identifying patients at risk for deterioration on the medical wards. What did this study ask? This study sought opinions from emergency department (ED) staff on the use of early warning scores in the ED. What did this study find? Emergency doctors and nurses did not value early warning scores despite quantitative data showing efficacy in the ED. Why does this study matter to clinicians? We gleaned insight into how to implement a computer-based early warning score into the ED to reduce morbidity and mortality from septic shock...
June 14, 2018: CJEM
Steven Grant
Evidence suggests that the identification and response to the deteriorating patient continues to be an ongoing concern, despite the widespread use of track and trigger score (TTS) systems. This article discusses the variations in the parameters included in the different TTS systems in use across the NHS and their sensitivity. Clinical guidelines and physiological theory are used to appraise the parameters allocated in the National Early Warning Score (NEWS 1 and 2), highlighting potential limitations of the tool...
June 14, 2018: British Journal of Nursing: BJN
Jelle L G Haitsma Mulier, Sander Rozemeijer, Jantine G Röttgering, Angelique M E Spoelstra-de Man, Paul W G Elbers, Pieter Roel Tuinman, Monique C de Waard, Heleen M Oudemans-van Straaten
BACKGROUND: Acute kidney injury (AKI) complicates shock. Diagnosis is based on rising creatinine, a late phenomenon. Intrarenal vasoconstriction occurs earlier. Measuring flow resistance in the renal circulation, Renal Resistive Index (RRI), could become part of vital organ function assessment using Doppler ultrasound. Our aim was to determine whether RRI on ICU admission is an early predictor and discriminator of AKI developed within the first week. METHODS: In this prospective cohort of mixed ICU patients with and without shock, RRI was measured <24-h of admission...
2018: PloS One
R S Nannan Panday, C P Subbe, L S van Galen, J Kellett, M Brabrand, C H Nickel, P W B Nanayakkara
Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems. We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Data sets were graded according to the National Early Warning Score (NEWS). Of 487 patients in whom NEWS could be calculated on discharge and again on re-admission, 39.6% had worse vital signs with a NEWS score difference ≥ 2 points while only 7...
2018: Acute Medicine
Marko Hoikka, Tom Silfvast, Tero I Ala-Kokko
OBJECTIVES: The prehospital research field has focused on studying patient survival in cardiac arrest, as well as acute coronary syndrome, stroke, and trauma. There is little known about the overall short-term mortality and its predictability in unselected prehospital patients. This study examines whether a prehospital National Early Warning Score (NEWS) predicts 1-day and 30-day mortalities. METHODS: Data from all emergency medical service (EMS) situations were coupled to the mortality data obtained from the Causes of Death Registry during a six-month period in Northern Finland...
June 7, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Peter J Watkinson, Marco A F Pimentel, David A Clifton, Lionel Tarassenko
AIMS OF STUDY: To develop and validate a centile-based early warning score using manually-recorded data (mCEWS). To compare mCEWS performance with a centile-based early warning score derived from continuously-acquired data (from bedside monitors, cCEWS), and with other published early warning scores. MATERIALS AND METHODS: We used an unsupervised approach to investigate the statistical properties of vital signs in an in-hospital patient population and construct an early-warning score from a "development" dataset...
June 4, 2018: Resuscitation
Mas'uud Ibnu Samsudin, Nan Liu, Sumanth Madhusudan Prabhakar, Shu-Ling Chong, Weng Kit Lye, Zhi Xiong Koh, Dagang Guo, R Rajesh, Andrew Fu Wah Ho, Marcus Eng Hock Ong
A quick, objective, non-invasive means of identifying high-risk septic patients in the emergency department (ED) can improve hospital outcomes through early, appropriate management. Heart rate variability (HRV) analysis has been correlated with mortality in critically ill patients. We aimed to develop a Singapore ED sepsis (SEDS) predictive model to assess the risk of 30-day in-hospital mortality in septic patients presenting to the ED. We used demographics, vital signs, and HRV parameters in model building and compared it with the modified early warning score (MEWS), national early warning score (NEWS), and quick sequential organ failure assessment (qSOFA) score...
June 2018: Medicine (Baltimore)
Cristiano André da Costa, Cristian F Pasluosta, Björn Eskofier, Denise Bandeira da Silva, Rodrigo da Rosa Righi
BACKGROUND: Large amounts of patient data are routinely manually collected in hospitals by using standalone medical devices, including vital signs. Such data is sometimes stored in spreadsheets, not forming part of patients' electronic health records, and is therefore difficult for caregivers to combine and analyze. One possible solution to overcome these limitations is the interconnection of medical devices via the Internet using a distributed platform, namely the Internet of Things...
June 2, 2018: Artificial Intelligence in Medicine
Gooske Douw, Getty Huisman-de Waal, Arthur R H van Zanten, Johannes G van der Hoeven, Lisette Schoonhoven
BACKGROUND: Rapid response systems aim to improve early recognition and treatment of deteriorating general ward patients. Sole reliance on deviating vital signs to escalate care in rapid response systems disregards nurses' judgments about a patient's condition based on worry and other indicators of deterioration. To make worry explicit, the Dutch-Early-Nurse-Worry-Indicator-Score was developed, summarising non-quantifiable signs of deterioration in the nine indicators: breathing, circulation, temperature, mentation, agitation, pain, unexpected trajectory, patient indicates not feeling well and nurses' subjective observations...
May 21, 2018: International Journal of Nursing Studies
Nathan W Manning, Charles D Warne, Philip M Meyers
Objective: To explore the effects of reperfusion grade rates on clinical outcomes in the setting of stent-retriever-based reperfusion therapy for anterior circulation stroke in early time windows. Methods: Systematic searching of Medline and Embase databases was performed to identify stroke trials of stent-retriever-based therapy versus standard care. Mixed effects meta-regression was used to analyze the trial-level association between reperfusion rates and clinical outcomes...
2018: Frontiers in Neurology
Xingli Yang, Yongquan Fu, Fangyu Hu, Liang Liang, Xingang Lei, Jiwu Zhang
With the improvement of the quality of clinical diagnosis and treatment, the traditional scheduled "ward round" mode cannot meet the demands for real-time monitoring of acute and critically ill patients. This paper introduces the Storm, a real-time data stream processing technology and its application in the real time disease early warning system. By collecting the clinical data flow and calculating the MEWS scores in real time, the system can identify the potential deterioration of the disease, and promptly notify the medical staff...
January 30, 2018: Zhongguo Yi Liao Qi Xie za Zhi, Chinese Journal of Medical Instrumentation
Orsola Gawronski, Christopher Parshuram, Corrado Cecchetti, Emanuela Tiozzo, Marta Luisa Ciofi Degli Atti, Immacolata Dall'Oglio, Gianna Scarselletta, Caterina Offidani, Massimiliano Raponi, Jos M Latour
Background: System-level interventions including rapid response teams and paediatric early warning scores have been designed to support escalation of care and prevent severe adverse events in hospital wards. Barriers and facilitators to escalation of care have been rarely explored in paediatric settings. Aim: This study explores the experiences of parents and healthcare professionals of in-hospital paediatric clinical deterioration events to identify factors associated with escalation of care...
2018: BMJ Paediatrics Open
Maren Sogstad, Randi Beate Tosterud
With increased responsibility for follow-up of patients in long-term care, the importance of accurate observations are reinforced. Here, health care professionals experience with the use of structured observations guides are studied. The results are based on five focus group interviews. The health care professionals states that the tools gives them confidence in their care delivery, it's structures their actions and enhance communication. However, the implementing require competence, training and focus over time...
2018: Studies in Health Technology and Informatics
Sandrine Thouvenin-Doulet, Claire Berger, Léonie Casagranda, Odile Oberlin, Perrine Marec-Berard, Hélène Pacquement, Catherine Guibout, Claire Freycon, Tan Dat N'Guyen, Pierre-Yves Bondiau, Anne Laprie, Delphine Berchery, Chiraz El-Fayech, Béatrice Trombert-Paviot, Florent de Vathaire
PURPOSE: To describe fecundity in female survivors of childhood cancer and consider the correlation with quality of life (QOL). MATERIALS AND METHODS: Of 1744 women treated for childhood cancer before the age of 15 years at one of eight French cancer treatment centers between 1948 and 1992, 1187 who were alive in 2005 were sent a self-administered questionnaire, including questions about health status, QOL (MOS SF-36), and fecundity. A standardized fecundity ratio (SFR) was calculated (SFR: observed/expected number of children) for each individual based on a national reference...
May 31, 2018: Journal of Adolescent and Young Adult Oncology
Lukas L Negrin, Anna Antoni, Stefan Hajdu, Thomas Heinz
Introduction: Due to the fact that early objective identification of polytraumatized patients in extremis is crucial for carrying out immediate life-saving measures, our objectives were to provide and scrutinize a definition that results in a particularly high mortality rate and to identify predictors of mortality in this group. Materials and Methods: A polytraumatized patient (ISS ≥ 16) was classified "in extremis" if five out of seven parameters (arterial paCO2 > 50 mmHg, hemoglobin < 9...
2018: BioMed Research International
Rob Donald, Tim Howells, Ian Piper, P Enblad, P Nilsson, I Chambers, B Gregson, G Citerio, K Kiening, J Neumann, A Ragauskas, J Sahuquillo, R Sinnott, A Stell
Traumatically brain injured (TBI) patients are at risk from secondary insults. Arterial hypotension, critically low blood pressure, is one of the most dangerous secondary insults and is related to poor outcome in patients. The overall aim of this study was to get proof of the concept that advanced statistical techniques (machine learning) are methods that are able to provide early warning of impending hypotensive events before they occur during neuro-critical care. A Bayesian artificial neural network (BANN) model predicting episodes of hypotension was developed using data from 104 patients selected from the BrainIT multi-center database...
May 24, 2018: Journal of Clinical Monitoring and Computing
Dongze Li, Yaxiong Zhou, Jing Yu, Haifang Yu, Yiqin Xia, Lin Zhang, William K K Wu, Zhi Zeng, Rong Yao, Yu Cao
BACKGROUND: Inflammation and thrombosis are involved in the development and progression of sepsis. A novel thrombo-inflammatory prognostic score (TIPS), based on both an inflammatory and a thrombus biomarker, was assessed for its ability to predict adverse outcomes of sepsis patients in the emergency department (ED). METHODS: This was a retrospective cohort study of sepsis patients. TIPS (range: 0-2) was predictive of adverse outcomes. Multivariable logistic regression analyses were performed to investigate the associations between TIPS and 28-day adverse outcomes...
May 24, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Juan C Rojas, Kyle A Carey, Dana P Edelson, Laura R Venable, Michael D Howell, Matthew M Churpek
RATIONALE: Patients transferred from the intensive care unit (ICU) to the wards who are later readmitted to the ICU have increased length of stay, healthcare expenditure, and mortality compared to those who are never readmitted. Improving risk-stratification for patients transferred to the wards could have important benefits for critically ill hospitalized patients. OBJECTIVE: We aimed to use a machine-learning technique to derive and validate an ICU readmission prediction model with variables available in the electronic health record (EHR) in real-time and compare it to previously published algorithms...
May 22, 2018: Annals of the American Thoracic Society
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