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Modified Early Warning System

Joseph M Blankush, Robbie Freeman, Joy McIlvaine, Trung Tran, Stephen Nassani, I Michael Leitman
Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO2), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload...
October 20, 2016: Journal of Clinical Monitoring and Computing
Thomas Desautels, Jacob Calvert, Jana Hoffman, Melissa Jay, Yaniv Kerem, Lisa Shieh, David Shimabukuro, Uli Chettipally, Mitchell D Feldman, Chris Barton, David J Wales, Ritankar Das
BACKGROUND: Sepsis is one of the leading causes of mortality in hospitalized patients. Despite this fact, a reliable means of predicting sepsis onset remains elusive. Early and accurate sepsis onset predictions could allow more aggressive and targeted therapy while maintaining antimicrobial stewardship. Existing detection methods suffer from low performance and often require time-consuming laboratory test results. OBJECTIVE: To study and validate a sepsis prediction method, InSight, for the new Sepsis-3 definitions in retrospective data, make predictions using a minimal set of variables from within the electronic health record data, compare the performance of this approach with existing scoring systems, and investigate the effects of data sparsity on InSight performance...
September 30, 2016: JMIR Medical Informatics
Kristina Krmpotic, Ann Van den Bruel, Anna-Theresa Lobos
OBJECTIVE: Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS: We conducted a modified Delphi study with 3 iterations, administered electronically...
October 2016: Hospital Pediatrics
Matthew M Churpek, Ashley Snyder, Xuan Han, Sarah Sokol, Natasha Pettit, Michael D Howell, Dana P Edelson
RATIONALE: The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU). OBJECTIVE: We sought to compare qSOFA to other commonly used early warning scores. METHODS: All admitted patients first meeting criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included...
September 20, 2016: American Journal of Respiratory and Critical Care Medicine
Qin Qin, Yiqin Xia, Yu Cao
OBJECTIVE: Shock, the most common severe emergency syndrome, has a complicated etiopathogenesis, is difficult to identify, progresses quickly, and is dangerous. Early identification and intervention play determining roles in the final outcomes of shock patients, but no specific scoring system for shock has been established to date. METHODS: We collected 292 shock patients and analyzed the correlation between 28-day prognosis and the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Modified Early Warning System (MEWS), and Sequential Organ Failure Assessment scoring systems...
September 2, 2016: Journal of Critical Care
Jacob Calvert, Thomas Desautels, Uli Chettipally, Christopher Barton, Jana Hoffman, Melissa Jay, Qingqing Mao, Hamid Mohamadlou, Ritankar Das
BACKGROUND: The presence of Alcohol Use Disorder (AUD) complicates the medical conditions of patients and increases the difficulty of detecting and predicting the onset of septic shock for patients in the ICU. METHODS: We have developed a high-performance sepsis prediction algorithm, InSight, which outperforms existing methods for AUD patient populations. InSight analyses a combination of singlets, doublets, and triplets of clinical measurements over time to generate a septic shock risk score...
June 2016: Annals of Medicine and Surgery
Jugoslav Achkoski, S Koceski, D Bogatinov, B Temelkovski, G Stevanovski, I Kocev
OBJECTIVES: This paper presents a remote triage support algorithm as a part of a complex military telemedicine system which provides continuous monitoring of soldiers' vital sign data gathered on-site using unobtrusive set of sensors. METHODS: The proposed fuzzy logic-based algorithm takes physiological data and classifies the casualties according to their health risk level, calculated following the Modified Early Warning Score (MEWS) methodology. RESULTS: To verify the algorithm, eight different evaluation scenarios using random vital sign data have been created...
July 14, 2016: Journal of the Royal Army Medical Corps
Michael J Kavanaugh, Joanne D So, Peter J Park, Konrad L Davis
INTRODUCTION: Risk stratification with the Modified Early Warning System (MEWS) or electronic cardiac arrest trigger (eCART) has been utilized with ward patients to preemptively identify high-risk patients who might benefit from enhanced monitoring, including early intensive care unit (ICU) transfer. In-hospital mortality from cardiac arrest is ∼80%, making preventative interventions an important focus area. ICUs have lower patient to nurse ratios than wards, resulting in less emphasis on the development of ICU early warning systems...
July 8, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
M F Scriba, G L Laing, J L Bruce, B Sartorius, D L Clarke
INTRODUCTION/BACKGROUND: This study compares planned repeat laparotomy (PR) with on-demand repeat laparotomy (OD) in a developing world setting. MATERIALS AND METHODS: This study was conducted over a 30-month study period (December 2012-May 2015) at Greys Hospital, Pietermaritzburg, South Africa. All trauma and general surgery adult patients requiring a single relaparotomy were included in this study. Prospectively gathered data entered into an established electronic registry were retrospectively analysed...
July 2016: World Journal of Surgery
Juan J Delgado-Hurtado, Andrea Berger, Amit B Bansal
BACKGROUND: Geisinger Health System implemented the Modified Early Warning Score (MEWS) in 2011 and is fully integrated to the Electronic Medical Record (EMR). Our objective was to assess whether the emergency department (ED) MEWS (auto-calculated by EMR) is associated with admission to the hospital, admission disposition, inpatient mortality, and length of stay (LOS) 4 years after its implementation. METHODS: A random sample of 3,000 patients' first encounter in the ED was extracted in the study period (between January 1, 2014 and May 31, 2015)...
2016: Journal of Community Hospital Internal Medicine Perspectives
Audrey Catherine Quinn, Tim Meek, Carl Waldmann
PURPOSE OF REVIEW: Early warning scores, early warning systems and rapid response systems, were established in 1999. In the UK, a National Early Warning Score was launched in 2013 and is now used throughout the National Health Service. In 2007, a firm recommendation was made by the maternal confidential death enquiry that maternity units should incorporate a modified early obstetric warning score chart into clinical practice. Although there was enthusiastic uptake of this recommendation, local recording systems vary throughout the country and there is now a need to revisit revise and standardize an obstetric early warning system (ObsEWS)...
June 2016: Current Opinion in Anaesthesiology
Isao Nishijima, Shouhei Oyadomari, Shuuto Maedomari, Risa Toma, Chisato Igei, Shinya Kobata, Jyun Koyama, Ryuichiro Tomori, Natsuki Kawamitsu, Yoshiki Yamamoto, Masafumi Tsuchida, Yoshihiro Tokeshi, Ryo Ikemura, Kazufumi Miyagi, Koichi Okiyama, Kiyoshi Iha
BACKGROUND: Physiological abnormalities are often observed in patients prior to cardiac arrest. A modified early warning score (MEWS) system was introduced, which aims to detect early abnormalities by grading vital signs, and the present study investigated its usefulness. METHODS: Based on previous reports, the Chubu Tokushukai Hospital-customized MEWS was developed in Okinawa, Japan. The MEWS was calculated among all inpatients, and the rates of in-hospital cardiac arrests (IHCAs) were compared according to the score...
2016: Journal of Intensive Care
Gitte Bunkenborg, Ingrid Poulsen, Karin Samuelson, Steen Ladelund, Jonas Åkeson
AIM: The aim of this study was to evaluate adherence to an intervention optimizing in-hospital monitoring practice, by introducing early warning scoring (EWS) of vital parameters. BACKGROUND: Interventions comprising EWS systems reduce in-hospital mortality, but evaluation of adherence to such interventions is required to correctly interpret interventional outcome. METHOD: Adherence was evaluated with a mixed-methods approach. Quantitative data, obtained pre-interventionally (2009) and postinterventionally (2010 and 2011), were used to calculate and compare time intervals between scorings of vital parameters...
February 2016: Applied Nursing Research: ANR
Jamie K Roney, Barbara Erin Whitley, Jessica C Maples, Lexie Scarborough Futrell, Kimberley A Stunkard, JoAnn D Long
AIMS AND OBJECTIVES: To evaluate current research evidence reporting outcomes from modified early warning scoring system tools utilisation to prevent failure to rescue in hospitalised adult medical-surgical/telemetry patients. BACKGROUND: Early sepsis detection exhibits clinical significance to practitioners and patients. Thorough and timely clinical observations, along with a willingness of nurses to call for help, are pivotal to survival of hospitalised patients...
December 2015: Journal of Clinical Nursing
Yan Wang, Wei Wei, Qingxu Deng, Wei Liu, Houbing Song
Cyber physical systems (CPS) sense the environment based on wireless sensor networks. The sensing data of such systems present the characteristics of massiveness and multi-dimensionality. As one of the major monitoring methods used in in safe production monitoring and disaster early-warning applications, skyline query algorithms are extensively adopted for multiple-objective decision analysis of these sensing data. With the expansion of network sizes, the amount of sensing data increases sharply. Then, how to improve the query efficiency of skyline query algorithms and reduce the transmission energy consumption become pressing and difficult to accomplish issues...
2016: Sensors
Sadanandavalli Retnaswami Chandra, Thomas Gregor Issac, Krishnan Ayyappan
First episode of psychosis can occur at any age and it can be primarily psychiatric or secondary to other occult diseases. It is of great therapeutic relevance to be cautious about organic etiology as early diagnosis can help in early initiation of disease modifying treatments. To study patients who presented with first episode of psychosis and later turned out to be due to lupus erythematosus with varying periods of delay. Details of patients who were considered as treatment unresponsive psychosis and later turned out to be due to vasculitis were entered in excel sheet and analyzed...
July 2015: Indian Journal of Psychological Medicine
Yi Liu, Jiameng Hu, Isaiah Snell-Feikema, Michael S VanBemmel, Aashis Lamsal, Michael C Wimberly
Satellite remote sensing produces an abundance of environmental data that can be used in the study of human health. To support the development of early warning systems for mosquito-borne diseases, we developed an open-source, client based software application to enable the Epidemiological Applications of Spatial Technologies (EASTWeb). Two major design decisions were full automation of the discovery, retrieval and processing of remote sensing data from multiple sources, and making the system easily modifiable in response to changes in data availability and user needs...
December 1, 2015: Environmental Modelling & Software: with Environment Data News
Regina W Urban, Mercy Mumba, Shirley D Martin, Janet Glowicz, Daisha J Cipher
This study addresses the development of a modified early warning system (MEWS) to predict hospital admissions from emergency departments (EDs) using the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). A MEWS score was created for each patient in the NHAMCS data set using the vital signs recorded at admission. Multiple logistic regression analyses indicated that for every 1 unit increase in the MEWS score, patients were 33% more likely to be admitted to the hospital for further care even after controlling for demographics...
October 2015: Advanced Emergency Nursing Journal
Muge Capan, Julie S Ivy, James R Wilson, Jeanne M Huddleston
The primary cause of preventable death in many hospitals is the failure to recognize and/or rescue patients from acute physiologic deterioration (APD). APD affects all hospitalized patients, potentially causing cardiac arrest and death. Identifying APD is difficult, and response timing is critical - delays in response represent a significant and modifiable patient safety issue. Hospitals have instituted rapid response systems or teams (RRT) to provide timely critical care for APD, with thresholds that trigger the involvement of critical care expertise...
October 21, 2015: Health Care Management Science
Alexander P Stark, Robert C Maciel, William Sheppard, Greg Sacks, O Joe Hines
In-hospital cardiopulmonary arrest can contribute significantly to publicly reported mortality rates. Systems to improve mortality are being implemented across all specialties. A review was conducted for all surgical patients >18 years of age who experienced a "Code Blue" event between January 1, 2013 and March 9, 2014 at a university hospital. A previously validated Modified Early Warning Score (MEWS) using routine vital signs and neurologic status was calculated at regular intervals preceding the event...
October 2015: American Surgeon
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