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Early AND warning AND score

R Isaacs, G Smith, L Gale-Andrews, M Wee, E van Teijlingen, D Bick, V Hundley
BACKGROUND: Paper-based charts remain the principal means of documenting the vital signs of hospitalised pregnant and postnatal women. However, poor chart design may contribute to both incorrect charting of data and clinical responses. We decided to identify design faults that might have an adverse clinical impact. METHODS: One hundred and twenty obstetric early warning charts and escalation protocols from consultant-led maternity units in the United Kingdom and the Channel Islands were analysed using an objective and systematic approach...
January 8, 2019: International Journal of Obstetric Anesthesia
Zerrin Defne Dundar, Sedat Kocak, Abdullah Sadik Girisgin
INTRODUCTION: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. METHODS: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study...
February 7, 2019: American Journal of Emergency Medicine
D J Saunders, L Bleasdale, L Summerton, A Hancock, S Homer-Vanniasinkam, D A Russell
OBJECTIVES: To assess the ability of a novel, automated CE marked vascular early warning system (VEWS) device to detect peripheral arterial disease in patients with incompressible ankle arteries and non-measurable ankle brachial pressure index (ABPI) secondary to diabetes. RESEARCH DESIGN AND METHODS: Recruited patients had diabetes, recent MRA evidence of PAD and incompressible vessels on ABPI. VEWS indices of each leg were automatically calculated by employing optical infrared and red sensors applied to the foot with readings obtained with the subject's leg both flat and elevated...
February 12, 2019: Annals of Vascular Surgery
Richard Grieve, Stephen O'Neill, Anirban Basu, Luke Keele, Kathryn M Rowan, Steve Harris
Importance: It is unknown which deteriorating ward patients benefit from intensive care unit (ICU) transfer. Objectives: To use an instrumental variable (IV) method that assesses heterogeneity and to evaluate estimates of person-centered treatment effects of ICU transfer and 28-day hospital mortality by age and illness severity. Design, Setting, and Participants: An analysis of a prospective cohort study from November 1, 2010, to December 31, 2011...
February 1, 2019: JAMA network open
Justin Lockwood, Jennifer Reese, Beth Wathen, Jacob Thomas, Mark Brittan, Melissa Iwanowski, Lisa McLeod
OBJECTIVES: To evaluate the association between fever and subsequent deterioration among patients with Pediatric Early Warning Score (PEWS) elevations to ≥4 to inform improvements to care escalation processes at our institution. METHODS: We performed a cohort study of hospitalized children at a single quaternary children's hospital with PEWS elevations to ≥4 between January 1, 2014 and March 31, 2014. Bivariable analysis was used to compare characteristics between patients with and without unplanned ICU transfers and critical deterioration events (CDEs) (ie, unplanned ICU transfers with life-sustaining interventions initiated in the first 12 ICU hours)...
February 13, 2019: Hospital Pediatrics
Neil Brimblecombe, Haddy Quist, Fiona Nolan
INTRODUCTION: Technological innovation offers opportunities to improve mental health care, however, little evidence exists regarding attitudes of inpatient staff and patients to such changes. We present a survey of staff and patients prior to introduction of a digital version of the National Early Warning Score (eNEWS) system for identifying physical deterioration. AIM: To collate views of staff and inpatients related to prospective use of eNEWS, to inform the plan for implementation...
February 11, 2019: Journal of Psychiatric and Mental Health Nursing
Gökhan Torun, Vahide Aslihan Durak
INTRODUCTION: Posttraumatic injuries are among the most frequent reasons of admission to emergency room services (ERs). In the first assessment of the cases, ATLS protocols recommends use of triage decision scheme consisting of parametres of abnormal physiologic findings, anatomic injury site, pathogenic mechanism of injury, concomitant diseases and conditions, and activation of trauma teams in line with these criteria. The aim of this study is to evaluate TEWS(Triage Early Warning Score) as a marker for predicting mortality in trauma patients who presented to Emergency Services...
February 4, 2019: Annali Italiani di Chirurgia
Calvin J Chiew, Nan Liu, Takashi Tagami, Ting Hway Wong, Zhi Xiong Koh, Marcus E H Ong
Early identification of high-risk septic patients in the emergency department (ED) may guide appropriate management and disposition, thereby improving outcomes. We compared the performance of machine learning models against conventional risk stratification tools, namely the Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and our previously described Singapore ED Sepsis (SEDS) model, in the prediction of 30-day in-hospital mortality (IHM) among suspected sepsis patients in the ED...
February 2019: Medicine (Baltimore)
Emanuele Torri, Marta Rigoni, Stefania Dorigoni, Dimitri Peterlana, Susanna Cozzio, Giandomenico Nollo, Walter Spagnolli
BACKGROUND: In medical wards, to guarantee safe, sustainable and effective treatments to heterogeneous and complex patients, care should be graduated into different levels of clinical intensity based on a standardised assessment of acute-illness severity. To support this assumption, we conducted a prospective observational study on all unselected admissions of 3,381 patients to a medium size internal Italian Medicine Unit by comparing Standard Medical Care model (SMC) to a new paradigm of patient admission based on Intensity of Medical Care (IMC)...
2019: PloS One
Xiaojun Wei, Haoli Ma, Ruining Liu, Yan Zhao
This study aimed to evaluate the performance of the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), and the modified early warning score (MEWS) in predicting the outcomes of adult patients presenting to the emergency department (ED).A retrospective review was undertaken between February 2014 and February 2018 in an adult ED of a 3300-bed university hospital. The RAPS, REMS, and MEWS were calculated to assess their capability to predict hospital admission, length of hospital stay, and in-hospital mortality, using area under receiver operating characteristic analysis...
February 2019: Medicine (Baltimore)
Valerie Danesh, Donna Neff, Terry L Jones, Karen Aroian, Lynn Unruh, Diane Andrews, Lotricia Guerrier, Sam J Venus, Edgar Jimenez
BACKGROUND: Unplanned escalations manifest as a breakdown of hospital care attributable to clinician error through missed or delayed identification of physiological instability, ineffective treatment, or iatrogenic harm. OBJECTIVES: To examine the impact of an Early Warning Score-based proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care compared with a rapid response team model based on staff nurse identification of vital sign derangements...
January 12, 2019: International Journal of Nursing Studies
Mariska Weenk, Mats Koeneman, Tom H van de Belt, Lucien J L P G Engelen, Harry van Goor, Sebastian J H Bredie
BACKGROUND: Clinical deterioration regularly occurs in hospitalized patients potentially resulting in life threatening events. Early warning scores (EWS), like the Modified Early Warning Score (MEWS), assist care givers in assessing patients' clinical situation, but cannot alert for deterioration between measurements. New devices, like the ViSi Mobile (VM) and HealthPatch (HP) allow for continuous monitoring and can alert deterioration in an earlier phase. VM and HP were tested regarding MEWS calculation compared to nurse measurements, and detection of high MEWS in periods between nurse observations...
January 24, 2019: Resuscitation
Gabriel J Escobar, Neeru R Gupta, Eileen M Walsh, Lauren Soltesz, Stephanie M Terry, Patricia Kipnis
Compared to adults admitted to general medical-surgical wards, women admitted to labor and delivery services are at much lower risk of experiencing unexpected critical illness. Nonetheless, critical illness and other complications that put either the mother or fetus at risk do occur. One potential approach to prevention is to use automated early warning systems such as those used for non-pregnant adults. Predictive models using data extracted in real time from electronic records constitute the cornerstone of such systems...
January 22, 2019: American Journal of Obstetrics and Gynecology
Anniek Brink, Jelmer Alsma, Rob Johannes Carel Gerardus Verdonschot, Pleunie Petronella Marie Rood, Robert Zietse, Hester Floor Lingsma, Stephanie Catherine Elisabeth Schuit
OBJECTIVE: In hospitalized patients, the risk of sepsis-related mortality can be assessed using the quick Sepsis-related Organ Failure Assessment (qSOFA). Currently, different tools that predict deterioration such as the National Early Warning Score (NEWS) have been introduced in clinical practice in Emergency Departments (ED) worldwide. It remains ambiguous which screening tool for mortality at the ED is best. The objective of this study was to evaluate the predictive performance for mortality of two sepsis-based scores (i...
2019: PloS One
Glen Wright Colopy, Stephen Roberts, David A Clifton
Patients in a hospital step-down unit require a level of care that is between that of the intensive care unit (ICU) and that of the general ward. While many patients remain physiologically stabilized, others will suffer clinical emergencies and be readmitted to the ICU, with a subsequent high risk of mortality. Had the associated physiological deterioration been detected early, the emergency may have been less severe or avoided entirely. Current clinical monitoring is largely heuristic, requiring manual calculation of risk scores and the use of heuristic decision criteria...
January 22, 2019: IEEE Journal of Biomedical and Health Informatics
Constance C Mussa, Afnan Al-Raimi, Ellen A Becker
BACKGROUND: The modified early warning score (MEWS) is used to detect early clinical deterioration and to escalate care as needed. Respiratory therapists (RTs) usually do not use the MEWS even when it is implemented as a default in the electronic health record system. This study explored whether the technology acceptance model could predict the intentions of RTs to use the MEWS. METHODS: A validated survey that uses a pretest/posttest design was used to determine the effect of an educational intervention (lecture and interactive small group session) on RTs' MEWS knowledge...
January 22, 2019: Respiratory Care
Ryan J Delahanty, JoAnn Alvarez, Lisa M Flynn, Robert L Sherwin, Spencer S Jones
STUDY OBJECTIVE: The Third International Consensus Definitions (Sepsis-3) Task Force recommended the use of the quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score to screen patients for sepsis outside of the ICU. However, subsequent studies raise concerns about the sensitivity of qSOFA as a screening tool. We aim to use machine learning to develop a new sepsis screening tool, the Risk of Sepsis (RoS) score, and compare it with a slate of benchmark sepsis-screening tools, including the Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment (SOFA), qSOFA, Modified Early Warning Score, and National Early Warning Score...
January 17, 2019: Annals of Emergency Medicine
Corrie Kangas, Lindsay Iverson, Dustin Pierce
Providing effective screening tools to nurses is necessary to improve patient outcomes and health care quality. This research examines if the modification of two electronic health record sepsis screening tools using a combined systemic inflammatory response syndrome (SIRS), modified early warning score (MEWS), and national early warning score (NEWS) criteria improves the recognition of sepsis by nurses. Medical-surgical/telemetry units at a medical center in the Midwest were examined using a quasiexperimental design...
January 17, 2019: Clinical Nursing Research
Bryan Williams
No abstract text is available yet for this article.
January 2019: Clinical Medicine: Journal of the Royal College of Physicians of London
Idar Johan Brekke, Lars Håland Puntervoll, Peter Bank Pedersen, John Kellett, Mikkel Brabrand
BACKGROUND: Vital signs, i.e. respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients. Changes in vital signs prior to clinical deterioration are well documented and early detection of preventable outcomes is key to timely intervention. Despite their role in clinical practice, how to best monitor and interpret them is still unclear. OBJECTIVE: To evaluate the ability of vital sign trends to predict clinical deterioration in patients hospitalized with acute illness...
2019: PloS One
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