DOCSLIB.ORG

Predictive Value of Modified Early Warning Score (MEWS)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Predictive Value of Modified Early Warning Score (MEWS) Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-041882 on 15 March 2021. Downloaded from Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short- term prognosis of emergency trauma patients: a retrospective study Zhejun Yu,1 Feng Xu,2 Du Chen 1 To cite: Yu Z, Xu F, Chen D. ABSTRACT Strengths and limitations of this study Predictive value of Modified Objectives This study aimed to assess the predictive Early Warning Score (MEWS) value of the Modified Early Warning Score (MEWS) and ► To the best of our knowledge, no other study has and Revised Trauma Score (RTS) Revised Trauma Score (RTS) for emergency trauma for the short- term prognosis of done a statistical comparison of these two scoring patients who died within 24 hours. emergency trauma patients: a systems in the field of early emergency trauma. Design A retrospective, single- centred study. retrospective study. BMJ Open ► Focus on early decision- making and rational use Setting This study was conducted at a tertiary hospital in 2021;11:e041882. doi:10.1136/ of trauma scoring system, to improve early triage Southern China. bmjopen-2020-041882 efficiency. Participants A total of 1739 patients with acute trauma, ► The retrospective nature of the study was a limita- ► Prepublication history for aged 16 years or older who presented to the emergency this paper is available online. tion, as it was not conducted in real-time and was department from 1 November 2016 to 30 November 2019, To view these files, please visit limited by subjective differences in artificial statisti- were included. the journal online (http:// dx. doi. cal results and differences in recording time. Interventions none None. org/ 10. 1136/ bmjopen- 2020- ► The environment of emergency trauma may also Outcome 24- hour mortality was the primary outcome of 041882). affect the quality of vital signs recorded, leading to trauma. underestimation of the extent of the patient’s physi- ZY and FX contributed equally. Results 1739 patients were divided into the survival cal disorders and deterioration. group (1709 patients,98.27%), and the non- survival group http://bmjopen.bmj.com/ Received 29 June 2020 (30 patients,1.73%). Crude OR and adjusted OR of MEWS Revised 28 November 2020 were 1.99, 95% CI (1.73 to 2.29), and 2.00, 95% CI (1.74 Accepted 06 January 2021 to 2.31), p<0.001, respectively. Crude OR and adjusted OR of trauma centres are facing great challenges. of RTS were 0.62, 95% CI (0.55 to 0.69) and 0.61, 95% CI In all emergency rooms, especially in cases of (0.55 to 0.68), p<0.001, respectively. The area under overcrowding and understaffing, it is critical the curve of MEWS was significantly higher than that of to rapidly screen large numbers of patients, RTS (p=0.005): 0.927, 95% CI (0.914 to 0.939) vs 0.799, identify the critically ill patients as quickly and 95% CI (0.779 to 0.817). appropriately as possible, assess the severity of Conclusions Both MEWS and RTS were independent on September 27, 2021 by guest. Protected copyright. predictors of the short- term prognosis in emergency their condition and assign appropriate treat- trauma patients, MEWS had better predictive efficacy. ment priorities, and transfer them towards or intensive care unit (ICU). Although risk © Author(s) (or their stratification has been developed for selected employer(s)) 2021. Re- use INTRODUCTION emergency patient groups, few attempts have permitted under CC BY-NC. No commercial re- use. See rights In most developed countries, a regional been made to develop a generic risk- adjusted 3 4 and permissions. Published by trauma system has been developed to triage score for emergency patients. BMJ. and divert patients with traumatic injuries to In the last 30 years, different trauma scoring 1Division of Critical Care appropriate trauma centres. Recent studies systems have been developed, most of which Medicine, The First Affiliated have shown a 25% reduction of mortality rate incorporate anatomical or physiological Hospital of Soochow University, in traumatic injuries if the care was offered components or both.5–9 However, these scores Suzhou, China 1 2Division of Emergency at trauma centres. In China, multiple trauma are either too complicated to calculate and Medicine, The First Affiliated is the fifth- leading cause of death. Each year, have too many variables to meet the require- Hospital of Soochow University, more than 400 000 people die from motor ments of rapid risk stratification tools in the Suzhou, China vehicle accidents or industrial accidents, emergency environment, or they cannot be Correspondence to among which 1%–1.8% were multiorgan/ widely used due to the limitation of users and 2 2 10–12 Dr Du Chen; multisystem injuries. China’s regional trauma endotracheal intubation. Perhaps the sdfyycd@ suda. edu. cn system is not yet mature, and the management best- known indicators for assessing trauma Yu Z, et al. BMJ Open 2021;11:e041882. doi:10.1136/bmjopen-2020-041882 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-041882 on 15 March 2021. Downloaded from severity and potential consequences are the Revised analysis, our study explored early triage indicators appli- Trauma Score (RTS), Injury Severity Score (ISS) and cable to trauma patients in the emergency room. Trauma Score- Injury Severity Scores (TRISS). Based on current research in the field of trauma, RTS remains the most widely used scoring system. RTS has been widely METHODS recognised for clinical decision making. Several articles Study design have evaluated the performance of RTS in the emergency A retrospective, single- centred study was conducted in the room as a triage and prediction tool. It can be used as an ED of a comprehensive tertiary hospital in Suzhou, China emergency department (ED) diagnostic tool to identify to evaluate the predictive value of MEWS and RTS for the patients with severe trauma.13–15 It is important to note short- term prognosis of emergency trauma patients. Since that these scores are not warning scores, but severity the data collected are essential for the diagnosis and clin- indicators.16 ical follow- up of patients, it is not considered necessary to Based on the need for a simple, fast and effective obtain informed consent from patients. Ensure patients’ trauma classification tool, the Modified Early Warning anonymity. Score (MEWS) is a qualified warning system. MEWS is Setting and participants a bedside assessment tool, and each of its variables can We retrospectively analysed the clinical data of 1739 be easily and quickly calculated. MEWS, combining with patients with acute trauma who were treated in the emer- vital signs and consciousness, covers the respiratory, gency room of The First Affiliated Hospital of Soochow circulatory and nervous systems, and reflects the overall University (a comprehensive tertiary adult hospital) from situation of patients with the simplest and most direct 1 November 2016 to 30 November 2019. The observation score. MEWS has been developed for use in wards and endpoint was death within 24 hours. Our study used an ICU/high dependency units patients as an early warning electronic medical record system to collect data for retro- system for adverse events in the hospital. It is also used spective analysis. Our data were recorded by attending to predict mortality and admissions to emergency rooms, nurses and doctors at the time of patients’ presentation but it is not a disease- specific score. Previous studies have to the ED. Because this was a short- term prognosis study, shown that MEWS is a good predictor of the prognosis we did not conduct telephone follow- up on the patient’s 17 18 of emergency trauma patients, yet other studies put survival status. Figure 1 shows the flow diagram of the 19 this conclusion in controversy. However, very few studies study. Inclusion criteria were: clear history of trauma, analysed patients with early trauma in the emergency final diagnosis of acute injury examined by imaging; age room. Our study evaluated the predictive value of MEWS not younger than 16 years; complete clinical and medical and RTS on 24- hour mortality among emergency trauma history. The following exclusion criteria were used: patients. Through retrospective chart review and data under 16 years of age;discharged from the ED before http://bmjopen.bmj.com/ on September 27, 2021 by guest. Protected copyright. Figure 1 Flow chart of the study procedure. ED, emergency department. 2 Yu Z, et al. BMJ Open 2021;11:e041882. doi:10.1136/bmjopen-2020-041882 Open access BMJ Open: first published as 10.1136/bmjopen-2020-041882 on 15 March 2021. Downloaded from 13 Table 1 Coding of the Revised Trauma Score (RTS) severity (table 1). Table 1 shows the components of, and scores for, each individual aspect of the RTS. Glasgow Systolic blood Respiratory rate The MEWS is widely used in the clinical setting as RTS Coma Scale pressure (mm Hg) (breaths/min) a quantified scoring system based on HR (beats per 4 13–15 >89 10–29 minute), SBP (mm Hg), RR(cycles per minute), T (°C) 3 9–12 76–89 >29 and Alert, responds to Voice, responds to Pain, Unre- 2 6–8 50–75 6–9 sponsive (AVPU). As reported previously, the AVPU is 1 4–5 1–49 1–5 estimated from the GCS as follows: A=14–15, V=9–13, p=4–8, U=3.20–22 The corresponding score, ranging from 0 3 0 0 0 to 3, for each variable is shown in table 2. In contrast to RTS, a higher MEWS indicates a worse state of patients. termination of emergency treatment; patients dead on Statistical analysis arrival; multiple referrals for patients who have under- Shapiro- Wilk test was used to test the normality of contin- gone emergency treatment and patients with incomplete uous variables.
Load more

Recommended publications
  • The Inclusion of Delirium in Version 2 of the National Early
    ORIGINAL ORIGINAL RESEARCH RESEARCH ClinicalClinical Medicine Medicine 2019 2017 Vol Vol 19, 17, No No 2: 6:104–8 104–8 CORE Metadata, citation and similar papers at core.ac.uk Provided by Bradford Scholars The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals Authors: M o h a m m e d A M o h a m m e d , A M u h a m m a d F a i s a l , B D o n a l d R i c h a r d s o n ,C A n d y S c a l l y , D R o b i n H o w e s , E K e v i n B e a t s o n , F S a l l y I r w i n G a n d K e v i n S p e e d H B a c k g r o u n d emergency medical patients. Rigorous evaluation of NEWS2 The National Early Warning Score (NEWS) is being replaced is required before widespread implementation because the with NEWS2 which adds 3 points for new confusion or delirium. extent to which staff can cope with this increase without We estimated the impact of adding delirium on the number of adverse consequences remains unknown. medium/high level alerts that are triggers to escalate care.
    [Show full text]
  • The Impact of Early Warning Scoring Systems
    General care Insights The impact of Early Warning Scoring systems: Better health outcomes, lower cost of care, and improved staff, patient and family experience Unmet needs and solutions: Response to the burden of patient deterioration Sizing the problem of patient deterioration Patient deterioration is a significant clinical and financial Patient deterioration may also result in a significant direct burden for patients, providers, and healthcare systems.2 economic burden for providers. Patients experiencing (Figure 1) Clinicians are increasingly treating older, sicker adverse events are associated with higher direct populations at risk for complications and in-hospital healthcare costs.9 adverse events.3 As the volume of hospitalizations for these patients continues to rise, providers are challenged A review of the literature highlights this trend, especially to manage more acute, resource intensive populations in among potentially preventable conditions: a resource-constrained environment.3 • Surgical complications were associated with a nearly $20K increase in hospital costs and a pronounced Compounded with a scarcity of beds in higher acuity decrease in contribution margin10 care areas, patient status may be underestimated, and • Median costs associated with sepsis are markedly patients may be admitted or transferred to lower acuity higher than in non-septic patients per case ($10K care areas while still at risk for deterioration and resulting United Kingdom, $23K Germany)11 serious adverse events. • $3,580 average cost per day of hospitalization for This scenario may be attributable to a relative lack of recipients of cardio pulmonary resuscitation12 resources in lower acuity settings, a significant decrease in nurse to patient ratios, and/or a lack of care coordination.
    [Show full text]
  • Modified Early Warning Scoring (MEWS) Tools Including Sepsis Screening Criteria
    Modified Early Warning Scoring (MEWS) Tools Including Sepsis Screening Criteria Literature Review Jamie K. Roney, MSN, RN-BC, CCRN-K Evaluating the Evidence for Use in Adult Medical-Surgical & Telemetry Patients Authors Jamie K. Roney, MSN, RN-BC, CCRN-K Erin Whitley, BSN, RN Jessica Maples, BSN, RN-BC Kimberley A. Stunkard, BSN, RN JoAnn D. Long, PhD, RN, NEA-BC Authors have no conflicts of interest, sponsorship, or commercial support to disclose Learning Objectives The learner will be able to: 1. Identify discoveries from a review of literature regarding combining sepsis screening criteria with MEWS tools. 2. Identify gaps in available published research linking MEWS usage with decreased failure to rescue events. Sepsis Outcomes MEWS Tools Screening Aims of Literature Review 1. Explore impact of MEWS tool usage on patient mortality & failure to rescue events in hospitalized adult medical- surgical/telemetry patients as reported in the literature 2. Validate MEWS physiologic screening parameters for incorporation of international sepsis identification standard values Provides foundation for MEWS tool adaptation recommendations for institutional use. Evaluating literature reporting MEWS tools impact & included screening criteria Background MEWS Tools Few studies have tested Patient Condition reliability & Subtle validity changes may go undetected Evidence Paucity of Patient Outcome data supports Screening outcome may decrease claims cardiopulmon ary arrests A review and evaluation of the MEWS literature was conducted Methods Objective Objective Sought to 5 Reviewers Sought to determine validate level of MEWS evidence & instruments’ examine impact on impact of use Literature significant of existing PRISMA* Evidence Table clinical tools in patient concluding Review outcomes what prior to physiologic making parameters recommendat should be Synthesis ions for included in incorporation the MEWS into clinical tool.
    [Show full text]
  • Using Early Warning Score in GE B105/B125 Patient Monitor for Covid-19 Patients
    Using Early Warning Score in GE B105/B125 Patient Monitor for Covid-19 patients gehealthcare.com ITALY Role of EWS for Covid-19 cases Recommendation report written by Emanuele Nicastri et all at As the COVID-19 pandemic spreads, it is straining the overall National lnstitttute for the Infectious Diseases "L. Spallanzani", healthcare infrastructure at all locations across the globe. The IRCCS, Rome, Italy, recommends course of treatment based on number of doctors and nurses are not sufficient compared to MEWS score for COVID-19 patients20 the inflow of patients. In such a resource constraint and highly Source: Emanuele Nicastri et al. Recommendations for COVID-19 Clinical contagious environment, it is even more important to monitor Management. National Institute for Infectious Diseases L. Spallanzani", IRCCS, Rome, the condition of the patient and take the right clinical decisions Italy. Infectious Disease Reports 2020; 12:8543 before it's too late. CLINICAL OBSERVATION EWS MONITORING FREQUENCY Based on Interim Clinical Guidance for Management of Patients Asymptomatic or mild with Confirmed Coronavirus Disease (COVID-19) by CDC NA 1-3 times a day infection Among patients who developed severe disease Stable patient presenting with respiratory/ systemic <3 Every 8 hours • Medium time to dyspnea: 5 to 8 days symptoms • Median time to ARDS (acute respiratory distress syndrome): Patient affected with 8 to 12 days respiratory symptoms, 3-4 Every 2 -4 hours • Median time to ICU admission ranged from 10 to 12 days. clinically unstable but not critical 26% to 32% of hospitalized patients need ICU Care Critical Patients >4 Continuous ARDS among COVID-19 Patients • 20% to 42% for hospitalized patients Swiss Society of Intensive Care Medicine • 67% to 85% of ICU Patients Inpatient management according to the Early Warning Score (EWS) Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset.
    [Show full text]
  • National Early Warning Score Systems That Alert to Deteriorating Adult Patients in Hospital
    pat hways National Early Warning Score systems that alert to deteriorating adult patients in hospital Medtech innovation briefing Published: 18 February 2020 www.nice.org.uk/guidance/mib205 This advice replaces MIB79. Summary • The 5 technologies described in this briefing are integrated software systems that output the national early warning score for adult patients in hospital. • The innovative aspects are the potential for more accurate alerts and the greater availability of this information to identify a deteriorating adult patient, thereby reducing avoidable harm and making services more efficient. • The intended place in therapy would be replacing paper-based charts that record observations and manually calculate the national early warning score. • The main points from the evidence summarised in this briefing are from 2 prospective studies and 1 multicentre retrospective observational study in the NHS. This limited evidence base suggests that electronic systems that send out national early warning score-based alerts can release staff resources, reduce unplanned admissions to intensive care and reduce the frequency of cardiac arrests, compared with standard care. © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 1 of conditions#notice-of-rights). 18 National Early Warning Score systems that alert to deteriorating adult patients in hospital (MIB205) • Key uncertainties are the lack of evidence for national early warning score-based alerts from these technologies in the NHS. Further research could improve understanding of how best to use them, and help determine the cost and resource impact. • The cost of early warning systems typically ranges from £30,000 to £90,000 for initial system installation, configuration and set up, with ongoing annual licence costs from £0.35 to £0.70 per acute bed, per day (exclusive of VAT).
    [Show full text]
  • Early Warning Systems
    HOSPITAL CHRONICLES 2012, VOLUME 7, SUPPLEMENT 1: 37–43 CARDIAC NURSING ROUNDTABLE Early Warning Systems Daphne Georgaka, RN, Maria Mparmparousi, RN, Michael Vitos, RN INTRODUCTION Coronary Care Unit, Evagelismos Currently, medical general wards tend to have a higher number of severely sick Hospital, Athens, Greece patients with a long period of critical illness. In addition, there is a growing recognition that several indicators of acute deterioration are being missed by both nurses and doc- tors. The consequences of these are an increase in the number of adverse events, such as cardiac arrest1 and in the number of patients admitted or readmitted in critical care units,2 contributing undoubtedly to higher mortality rates. As a result, many initiatives have been designed trying to reduce such problems, including the development of early warning scoring systems with the perspective of timely medical response. The aim of this project is to elucidate the dimensions of early warning systems (EWS), to raise discussion on their validity and to stimulate health leadership in in- KEY WORDS: early warning systems; health care; health risk; critical care; troducing early warning systems into health care mechanisms. After having collected intensice care unit; nursing care and presented data from several recent articles on the topic, this project intends to discuss about the introduction and function of EWS. WHAT EARLY WARNING SYSTEMS ARE The application of EWS is not a novel approach restricted solely to medical fields. These systems were first designed for the timely identification of ecological and finan- cial risks. The need for gathering data and information on time, sharing information within different regimes and establishing models for calculation and analysis methods introduced the use of these “tools”.3 These systems were initially applied for the detec- tion of economic weakness and vulnerability.
    [Show full text]
  • New Zealand Early Warning Score Vital Sign Chart User Guide 2017
    New Zealand Early Warning Score Vital Sign Chart User Guide 2017 July 2017 Contents Contents ............................................................................................................................... 2 Figures .............................................................................................................................. 3 1. Introduction .................................................................................................................... 4 2. Chart overview ............................................................................................................... 4 2.1. Section 1: graphing area ............................................................................................. 5 2.2. Section 2: escalation pathway .................................................................................... 5 2.3 Section 3: NZEWS modifications ................................................................................. 5 2.4. Section 4: additional parameters ................................................................................ 6 3. Clinical use .................................................................................................................... 6 3.1. Documenting vital signs .............................................................................................. 6 3.1.1 Respiratory rate .................................................................................................... 6 3.1.2. Supplementary oxygen........................................................................................
    [Show full text]
  • The Admission Hamilton Early Warning Score (HEWS)
    Original Research The Admission Hamilton Early Warning Score (HEWS) Predicts the Risk of Critical Event during Hospitalization Benjamin Tam BHSc MD, Michael Xu BHSc, Michelle Kwong BHSc Cand., Christine Wardell BHSc Cand., Andrew Kwong BHSc Cand., Alison Fox-Robichaud MSc MD FRCPC About the Authors: Lead author Benjamin Tam is an internist and a trainee in the Adult Critical Care Medicine residency program at McMaster University in Hamilton, Ontario. His interest is in patient safety, particularly the use of rapid response teams and early warning scores to reduce critical events and improve the patient experience. Co-authors Michael, Xu, Michelle Kwong, Christine Wardell, Andrew Kwong are BHSc Candidates at McMaster University. Principal investigator and corresponding author Alison Fox-Robichaud is with the Department of Medicine, Division of Critical Care, Faculty of Health Sciences, McMaster University. Correspondence may be directed to [email protected]. Benjamin Tam Abstract Background: Early warning scores detect patients at risk of deterioration in hospital. Our objective was to first, demonstrate that the admission Hamilton Early Warning Score (HEWS) predicts critical events and second, estimate the workload required to identify critical events during hospitalization. Methods: We prospectively identified a consecutive cohort of medical/surgical patients for retrospective review. Critical events were defined as a composite of inpatient death, cardio-pulmonary arrest or ICU transfer. Likelihood of a critical event during hospitalization and the number needed to evaluate to detect a critical event was based on highest admission HEWS. Results: We found 506 critical events occurred in 7130 cases. HEWS identified graduated levels of risk at admission. We found 2.6 and 1.8 patients needed to be evaluated in the ‘high-risk’ and very ‘high-risk’ subgroups to detect a critical event.
    [Show full text]
  • Performance of the Maximum Modified Early Warning Score to Predict The
    ORIGINAL RESEARCH Performance of the Maximum Modified Early Warning Score to Predict the Need for Higher Care Utilization Among Admitted Emergency Department Patients 1 1 Corey R. Heitz, MD Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, 1 John P. Gaillard, MD North Carolina. 1 Howard Blumstein, MD 2 2 Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, Doug Case, PhD 3 North Carolina. Catherine Messick, MD 1 3 Chadwick D. Miller, MD Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. This study was supported in part by the Division of Healthcare Research and Quality of Wake Forest University Baptist Medical Center. Financial support for Dr. Miller is provided by a research scholar award from the Wake Forest University Translational Science Institute. Disclosure: Nothing to report. BACKGROUND: It is uncertain whether ED-calculated risk scores can predict required intensity of care upon hospital admission. This investigation examines whether versions of the Modified Early Warning Score (MEWS) predict high level of care utilization among patients admitted from the ED. METHODS: A retrospective chart review of 299 admissions was implemented. Exclusions prior to abstraction included pediatrics, cardiology, or trauma admissions. Using a data-gathering instrument, abstractors recorded physiologic parameters and clinical variables. Risk scores were calculated electronically. In contrast to the original MEWS, the MEWS Max was calculated using data from the entire ED visit. The primary outcome composite included all-cause mortality and higher care utilization within 24 hours. RESULTS: The final analysis contained 280 participants. 76 (27%) met the composite endpoint of death (n ¼ 1) or higher care utilization (n ¼ 76).
    [Show full text]
  • (INEWS) V2 (Previously NEWS) National Clinical Guideline No
    Irish National Early Warning System (INEWS) V2 (previously NEWS) National Clinical Guideline No. 1 September 2020 National Patient Safety Office Oifig Náisiúnta um Shábháilteacht Othar The Nati onal Early Warning Score (NEWS) Nati onal Clinical Guideline has been updated and revised by the Irish Nati onal Early Warning System (INEWS) Guideline Development Group (GDG) under the auspices of the HSE Nati onal Deteriorati ng Pati ent Recogniti on and Response Improvement Programme (DPIP). Using this Nati onal Clinical Guideline This Nati onal Clinical Guideline applies to adult (≥ 16 years) non-pregnant pati ents in acute setti ngs. It does not apply to children or pati ents in obstetric care. This Nati onal Clinical Guideline is relevant to all healthcare professionals working in acute setti ngs. Disclaimer NCEC Nati onal Clinical Guidelines do not replace professional judgment on parti cular cases, whereby the clinician or health professional decides that individual guideline recommendati ons are not appropriate in the circumstances presented by an individual pati ent, or whereby an individual pati ent declines a recommendati on as a course of acti on in their care or treatment plan. In these circumstances the decision not to follow a recommendati on should be appropriately recorded in the pati ent’s healthcare record. Users of NCEC Nati onal Clinical Guidelines must ensure they have the current version (hardcopy or soft copy) by checking the relevant secti on in the Nati onal Pati ent Safety Offi ce on the Department of Health website: htt ps://www.gov.ie/en/collecti on/c9fa9a-nati onal-clinical-guidelines/ Published by: The Department of Health, Block 1, Miesian Plaza, 50-58 Lower Baggot Street, Dublin 2, D02 VW90, Ireland.
    [Show full text]
  • (NEWS2) for COVID-19
    Carr et al. BMC Medicine (2021) 19:23 https://doi.org/10.1186/s12916-020-01893-3 RESEARCH ARTICLE Open Access Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study Ewan Carr1*† , Rebecca Bendayan1,2†, Daniel Bean1,3, Matt Stammers4,5,6, Wenjuan Wang7, Huayu Zhang8, Thomas Searle1,2, Zeljko Kraljevic1, Anthony Shek9, Hang T. T. Phan4,5, Walter Muruet7, Rishi K. Gupta10, Anthony J. Shinton6, Mike Wyatt11, Ting Shi8, Xin Zhang12, Andrew Pickles1,2, Daniel Stahl1, Rosita Zakeri13,14, Mahdad Noursadeghi15, Kevin O’Gallagher13,14, Matt Rogers11, Amos Folarin1,3,16,17, Andreas Karwath18,19,20, Kristin E. Wickstrøm21, Alvaro Köhn-Luque22, Luke Slater18,19,20, Victor Roth Cardoso18,19,20, Christopher Bourdeaux11, Aleksander Rygh Holten23, Simon Ball20,24, Chris McWilliams25, Lukasz Roguski3,16,19, Florina Borca4,5,6, James Batchelor4, Erik Koldberg Amundsen21, Xiaodong Wu26,27, Georgios V. Gkoutos18,19,20,24, Jiaxing Sun26, Ashwin Pinto6, Bruce Guthrie8, Cormac Breen7, Abdel Douiri7, Honghan Wu3,16, Vasa Curcin7, James T. Teo9,13†, Ajay M. Shah13,14† and Richard J. B. Dobson1,2,3,16,17† Abstract Background: The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification. Methods: Training cohorts comprised 1276 patients admitted to King’s College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020.
    [Show full text]
  • Vital Signs and Introduction to NEWS Samantha Coulter, 4Th Year Medical Student Dr Jason Long, Director of Clinical Skills
    Vital Signs and Introduction to NEWS Samantha Coulter, 4th Year Medical Student Dr Jason Long, Director of Clinical Skills Contents Learning Outcomes ........................................................................................................................... 3 Introduction to Vital Signs ................................................................................................................. 3 National Early Warning Score ............................................................................................................ 3 Assessment of Radial Pulse ............................................................................................................... 4 Method ..................................................................................................................................... 4 Blood Pressure .................................................................................................................................. 5 What Blood Pressure Numbers Mean ........................................................................................ 5 Hypertension vs Hypotension .................................................................................................... 6 Introduction to Sphygmomanometry ......................................................................................... 6 Blood Pressure Equipment ........................................................................................................ 7 Method ....................................................................................................................................
    [Show full text]