Ola Friman1,2, Max Bell1,2, Therese Djärv3,4, Andreas Hvarfner1, Gabriella Jäderling1,2. 1. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. 3. Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Abstract
PURPOSE: The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events. METHODS: Point prevalence study of vital parameters according to NEWS and RRT criteria of all adult patients admitted to general wards at a Scandinavian university hospital with a mature RRT. PRIMARY OUTCOME: prevalence of at-risk patients fulfilling at least one RRT criteria, total NEWS of 7 or greater or a single NEWS parameter of 3 (red NEWS). SECONDARY OUTCOMES: mortality in-hospital and within 30 days or adverse events within 24 hours. RESULTS: We assessed 598 (75%) of 798 admitted patients and examiners captured a fulfilled RRT calling criterion in 50 patients (8.4%), 36 (6.0%) had NEWS ≥ 7, 34 with a red NEWS parameter. Red NEWS occurred in 112 patients (18.7%). Secondary outcomes were fulfilled in 49 patients (8.2%). Mortality overall was 6.5% within 30 days, 1.8% in hospital. In 134 patients (22.4%) the manual calculation of score for NEWS was incorrectly performed by examiner. CONCLUSION: Even with a mature RRT in place, we captured patients with failing physiology in general wards reflecting afferent limb failure. Manual calculation of NEWS is frequently incorrect, possibly leading to misclassification of patients at risk.
PURPOSE: The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events. METHODS: Point prevalence study of vital parameters according to NEWS and RRT criteria of all adult patients admitted to general wards at a Scandinavian university hospital with a mature RRT. PRIMARY OUTCOME: prevalence of at-risk patients fulfilling at least one RRT criteria, total NEWS of 7 or greater or a single NEWS parameter of 3 (red NEWS). SECONDARY OUTCOMES: mortality in-hospital and within 30 days or adverse events within 24 hours. RESULTS: We assessed 598 (75%) of 798 admitted patients and examiners captured a fulfilled RRT calling criterion in 50 patients (8.4%), 36 (6.0%) had NEWS ≥ 7, 34 with a red NEWS parameter. Red NEWS occurred in 112 patients (18.7%). Secondary outcomes were fulfilled in 49 patients (8.2%). Mortality overall was 6.5% within 30 days, 1.8% in hospital. In 134 patients (22.4%) the manual calculation of score for NEWS was incorrectly performed by examiner. CONCLUSION: Even with a mature RRT in place, we captured patients with failing physiology in general wards reflecting afferent limb failure. Manual calculation of NEWS is frequently incorrect, possibly leading to misclassification of patients at risk.
Authors: Raphael Kazidule Kayambankadzanja; Carl Otto Schell; Grace Nsanjama; Isaac Mbingwani; Samson Kwazizira Mndolo; Jamie Rylance; Tim Baker Journal: Emerg Med Int Date: 2019-07-07 Impact factor: 1.112
Authors: Anna Thorén; Eva Joelsson-Alm; Martin Spångfors; Araz Rawshani; Thomas Kahan; Johan Engdahl; Martin Jonsson; Therese Djärv Journal: Resusc Plus Date: 2021-12-24