Santiago Romero-Brufau1, Jeanne M Huddleston2, James M Naessens3, Matthew G Johnson3, Joel Hickman3, Bruce W Morlan3, Jeffrey B Jensen4, Sean M Caples5, Jennifer L Elmer6, Julie A Schmidt6, Timothy I Morgenthaler5, Paula J Santrach7. 1. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States. 2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: huddleston.jeanne@mayo.edu. 3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 4. Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 5. Division of Pulmonary Medicine and Critical Care, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 6. Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. 7. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Abstract
INTRODUCTION: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. METHODS: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. RESULTS: PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. CONCLUSIONS: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.
INTRODUCTION: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. METHODS: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. RESULTS: PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. CONCLUSIONS: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.
Authors: Daniel T Linnen; Gabriel J Escobar; Xiao Hu; Elizabeth Scruth; Vincent Liu; Caroline Stephens Journal: J Hosp Med Date: 2019-03 Impact factor: 2.960
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Authors: Fabio Tagliabue; Daniele Schena; Luca Galassi; Matteo Magni; Guglielmo Guerrazzi; Andrea Acerbis; Christina Rinallo; Daniel Longhi; Alberto Ronzani; Pierpaolo Mariani Journal: SN Compr Clin Med Date: 2021-06-18