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Chawla, Arun, Sunil Pillai Bhaskara, Ravi Taori, et al. "Evaluation of early scoring predictors for expedited care in patients with emphysematous pyelonephritis." Therapeutic Advances in Urology 14 (January 2022): 175628722210787. http://dx.doi.org/10.1177/17562872221078773.
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Introduction: Emphysematous pyelonephritis (EPN), an acute necrotizing infection of the kidney and surrounding tissues, is associated with considerable mortality. We evaluated how existing critical care scoring systems could predict the need for intensive care unit (ICU) management for these patients. We also analyzed if CT-imaging further enhances these predictive systems. Patients and Methods: A retrospective analysis of 90 consecutive patients diagnosed clinico-radiologically with EPN from January 2011 to September 2020. Five scoring systems were evaluated for their predictive ability for the need for ICU management and mortality risk: National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), ‘quick’ Sequential Organ Failure Assessment score (qSOFA), Systemic Inflammatory Response Syndrome score (SIRS), and Sequential Organ Failure Assessment score (SOFA). CT images were classified as per Huang & Tseng and evaluated as stand-alone or added to the different predictive models. Receiver operating characteristic (ROC) curves were plotted for each critical care score and CT-Class using logistic regression, to obtain the area under curve (AUC) value for comparison of ICU admission predictability. Patients were analyzed up till discharge. Results: Ninety patients were diagnosed with EPN. Twenty-six patients required ICU management and nine patients died. The best scoring system to predict the need of early ICU management is NEWS (AUC 0.884). CT Class had no independent predictive power, nor did it add significantly to improvement in most of the early warning scoring systems, but rather guided us to the need for radiological, endourological or surgical intervention. Conclusion: In patients with EPN, the NEWS scoring system predicts best the requirement of ICU care. It aids in triage of patients with EPN to appropriate early management and reduce mortality risk.
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Patriajati, Aji. "Differences of The Number of Maternal References In Semarang Public Health Center Based on MEOWS Scoring System." Diponegoro International Medical Journal 2, no. 2 (2021): 54–62. http://dx.doi.org/10.14710/dimj.v2i2.11120.
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Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion:The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion: The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.
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Tangkulpanich, Panvilai, Noraset Uppariputtanggoon, and Kasamon Aramvanitch. "The Performances of Multiple Scoring Systems to Predict Patients Required Immediate Life-Saving Intervention in Emergency Department." Ramathibodi Medical Journal 42, no. 3 (2019): 1–11. http://dx.doi.org/10.33165/rmj.2019.42.3.138690.
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Background: Crowding in emergency room is the major problem especially in the resuscitation room. Many patients require immediate life-saving interventions (LSI). Whereas, many different scoring systems such as national early warning score (NEWS), worthing physiological scoring system (WPS), modified early warning score (MEWS), and rapid emergency medicine score (REMS) have been developed for assessing patients at risk.
 Objective: To evaluate the effectiveness of 4 scoring systems performance in predicting LSI use in emergency room and reenter to the resuscitation room within 48 hours.
 Methods: Data were collected by a retrospective cross-sectional study of patients treated in the resuscitation room for 2 months period, at Ramathibodi Hospital. The number of patients who received LSI and reentry to resuscitation room were studied, compared by selected scoring systems.
 Results: Total 839 patients entered resuscitation room, while 331 (39.45%) patients received LSI. The first three groups at risk were metabolic diseases, gastrointestinal systems, and infections, respectively. The most effective scoring system in predicting patients required LSI was MEWS, the discrimination of this system was significantly better than NEWS (AUC, 0.69 vs 0.65; 95% CI, 0.65 - 0.72; P = .01). Eighty-six patients (13.89%) from 619 patients reentered to the resuscitation room. Moreover, NEWS was the most effective in predicting patients who had a risk of reenter (AUC, 0.72; 95% CI, 0.66 - 0.78; P < .001).
 Conclusions: MEWS is the most effective scoring system for patient assessment of LSI utilization. However, NEWS is the one suitable for predicting reenter tendency.
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Triantafyllidou, Christina, Petros Effraimidis, Konstantinos Vougas, Jonas Agholme, Mirjam Schimanke, and Karin Cederquist. "The Role of Early Warning Scoring Systems NEWS and MEWS in the Acute Exacerbation of COPD." Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine 17 (January 2023): 117954842311523. http://dx.doi.org/10.1177/11795484231152305.
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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the most devastating events in the course of the disease. Our aim was to investigate the value of early warning scoring systems: National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in AECOPD. This is a prospective observational study of patients with AECOPD who were admitted at hospital. The NEWS and MEWS scores were registered at admission (NEWS-d1, MEWS-d1) and on the second day (NEWS-d2, MEWS-d2). A nasopharyngeal and sputum sample was taken for culture. Follow-up was done at 3 and 6 months after hospitalization. Any possible correlations between NEWS and MEWS and other parameters of COPD were explored. A cohort of 64 patients were included. In-hospital mortality was 4.7% while total mortality at 6 months was 26%. We did not find any significant correlation between in-hospital mortality and any of the scores but we could show a higher mortality and more frequent AECOPD at 6 months of follow-up for those with higher NEWS-d2. NEWS-d2 was associated with higher pCO2 at presentation and a more frequent use of NIV. Higher NEWS-d1 and NEWS-d2 were predictive of a longer hospital stay. The presence of pathogens in the nasopharyngeal sample was related with a higher reduction of both scores on the second day. We therefore support the superiority of NEWS in the evaluation of hospitalized patients with AECOPD. A remaining high NEWS at the second day of hospital stay signals a high risk of hypercapnia and need of NIV but also higher mortality and more frequent exacerbations at 6 months after AECOPD.
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Majidinejad, Saeed, Farhad Heydari, Ahmad Ahmadi, Mohammad Nasr-Esfahani, Hossein Shayannejad, and NedaAl-Sadat Fatemi. "A comparison between modified early warning score, worthing physiological scoring system, national early warning score, and rapid emergency medicine score in predicting inhospital mortality in multiple trauma patients." Archives of Trauma Research 10, no. 4 (2021): 188. http://dx.doi.org/10.4103/atr.atr_31_21.
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Lee, Heayon, Bora Lee, Hyun Joo Youn, Choong Hee Cho, Jin Hee Lee, and Sei Won Kim. "Clinical frailty scale at ICU discharge predicts ICU readmission and post-ICU mortality: A retrospective single-center study." Medicine 104, no. 25 (2025): e42955. https://doi.org/10.1097/md.0000000000042955.
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Despite successful discharge from the intensive care unit (ICU), a substantial number of patients remain at risk of ICU readmission or death. Identifying high-risk individuals at the time of ICU discharge is essential for planning post-ICU care. This study aimed to assess the Clinical Frailty Scale (CFS) at ICU discharge as a screening tool for predicting ICU readmission and post-ICU mortality, and to compare its predictive performance with other commonly used scoring systems. We conducted a retrospective single-center study including adult patients (≥20 years) discharged from all ICUs to general wards. Patients discharged for non-recovery purposes were excluded. Within 24 hours of ICU discharge, clinical scores: Acute Physiology and Chronic Health Evaluation II, Modified Early Warning Score, National Early Warning Score, Sequential Organ Failure Assessment (SOFA), and CFS, were assessed. The primary outcome was a composite of ICU readmission or all-cause mortality after ICU discharge. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A total of 648 patients were included. ICU readmission or post-ICU mortality occurred in 6.5% of patients. Compared to others, these patients had significantly higher Charlson Comorbidity Index scores (P = .002), more frequent delirium (P < .001), and received more intensive interventions such as mechanical ventilation or high-flow oxygen (P < .001), vasopressors (P < .001), and hemodialysis (P < .001). In multivariate analysis, both SOFA score (P < .001) and CFS score (P = .002) remained independent predictors of adverse outcomes. CFS demonstrated the highest discriminative ability (area under the curve, 0.788) compared to SOFA (0.722), Acute Physiology and Chronic Health Evaluation II (0.718), National Early Warning Score (0.725), and Modified Early Warning Score (0.695). The CFS assessed at ICU discharge is a simple, accessible, and effective tool for predicting ICU readmission and post-ICU mortality. Compared to other commonly used scores, CFS demonstrated favorable predictive performance and may serve as a practical option for routine discharge planning and risk stratification in post-ICU care.
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Kim, Chulho, Jae Jun Lee, Jong-Hee Sohn, Jong-Ho Kim, Dong-Ok Won, and Sang-Hwa Lee. "Comparison of early warning scoring systems for predicting stroke occurrence among hospitalized patients: A study using smart clinical data warehouse." PLOS ONE 20, no. 1 (2025): e0316068. https://doi.org/10.1371/journal.pone.0316068.
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Background This study aimed to evaluate the predictive ability of two widely used early warning scoring systems, the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS), for predicting stroke occurrence in hospitalized patients. Methods The study enrolled 5,474 patients admitted to the intensive care unit from the general ward using data from the Smart Clinical Data Warehouse (CDW). MEWS and NEWS were calculated based on vital signs and clinical parameters within four hours of stroke onset. Stroke occurrence was categorized as ischemic or hemorrhagic. Logistic regression and receiver operating characteristic curve analyses were performed to assess the predictive abilities of the scoring systems. Results Of the enrolled patients, 33.9% (n = 1853) experienced stroke, comprising 783 cases of ischemic stroke and 1,070 cases of hemorrhagic stroke. Both the MEWS and the NEWS were found to significantly predict overall stroke occurrence with a cutoff value of 4 (MEWS>4; OR [95% CI]: 13.90 [11.51–16.79], p<0.001; NEWS>4; OR [95% CI]: 6.71 [5.75–7.83], p<0.001). Parameters, such as prior malignancy, atrial fibrillation, AVPU response, heart rate, respiratory rate, and oxygen saturation, are also associated with stroke occurrence. The predictive ability of MEWS and NEWS was good for overall stroke occurrence. (AUC of MEWS: 0.92, 95% CI [0.91–0.93], p<0.001; AUC of NEWS: 0.85, 95% CI [0.84–0.86], p<0.001). The predictive ability was considered fair for ischemic stroke but good for hemorrhagic stroke. Conclusion MEWS and NEWS demonstrated significant predictive abilities for overall stroke occurrence among hospitalized patients, with MEWS slightly outperforming NEWS.
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Thodphetch, Manita, Boriboon Chenthanakij, Borwon Wittayachamnankul, Kamphee Sruamsiri, and Theerapon Tangsuwanaruk. "A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection." Clinical and Experimental Emergency Medicine 8, no. 4 (2021): 289–95. http://dx.doi.org/10.15441/ceem.20.145.
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Objective We aimed to compare the modified National Early Warning Score (mNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, modified Systemic Inflammatory Response Syndrome (mSIRS) score, and modified Search Out Severity (mSOS) score in predicting mortality and sepsis among patients suspected of first observed infections in the emergency department. The modified scores were created by removing variables for simplicity.Methods This was a prospective cohort study that enrolled adult patients presenting at the emergency department with signs and symptoms suggesting infection. The mNEWS, qSOFA score, mSIRS score, and mSOS score were calculated using triage data. The SOFA score was a reference standard for sepsis diagnosis. All patients were monitored for up to 30 days after the initial visit to measure each scoring system’s ability to predict 30-day mortality and sepsis.Results There were 260 patients included in the study. The 30-day mortality prediction with mNEWS ≥5 had the highest sensitivity (91.18%). The highest area under the receiver operating characteristic curve (AUC) for the 30-day mortality prediction was mNEWS (0.607), followed by qSOFA (0.605), mSOS (0.550), and mSIRS (0.423). The sepsis prediction with mNEWS ≥5 had the highest sensitivity (96.48%). The highest AUC for the sepsis prediction was also mNEWS (0.685), followed by qSOFA (0.605), mSOS (0.480), and mSIRS (0.477).Conclusion mNEWS was an acceptable scoring system screening tool for predicting mortality and sepsis in patients with a suspected infection.
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Özdemir, Serdar. "Improving Clinical Decision-Making: A Focus on Early Warning Systems and Scoring Methods." Medical Science and Discovery 10, no. 6 (2023): 430–31. http://dx.doi.org/10.36472/msd.v10i6.962.
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Dear Editor, Examinations, laboratory tests, radiology, and clinical experience are required to make the most appropriate clinical decisions. There is no single universal clinical decision-making method advocated in routine medical literature. Often, this process is driven by experience, exploration, and clinical gestalt. Clinician management serves as a subjective decision tool in disease management. It has been extensively studied in the literature, particularly in entities such as pulmonary embolism, difficult airway prediction, and severe COVID-19 (1). By combining parameters such as laboratory-vital parameters and combined hematological parameters, clinical decision-making tools have been developed (2-3). Early warning systems (EWS) help predict which patients will require critical care by evaluating physiological parameters in busy and crowded workspaces. These scores, which can be measured through vital parameters and a simple physical examination, ensure the effective use of resources (4). In intensive care units (ICUs), complex systems are used to predict mortality. APACHE II is the most well-known score used in intensive care, consisting of many parameters that are computationally difficult. Vital parameters, biochemical tests, and blood gas analysis results are used when calculating APACHE II (5). On the other hand, important features of scores used in the emergency department are their quick and easy calculation, requiring no professional knowledge. The VitalPAC Early Warning Score (ViEWS), developed by Prytherch et al. in 2010, is an EWS that includes six physiological parameters. This score records the pulse rate, systolic blood pressure, respiratory minute rate, body temperature, level of consciousness (assessed by AVPU), and peripheral oxygen saturation (SpO2) parameters. ViEWS is created based on the degree of deviation of these six parameters from their normal ranges. Additional points are given if the patient receives oxygen support. The total ViEWS value, calculated by considering each parameter, provides information about the patient's prognosis (6). By adding the rapid lactate level to ViEWS (ViEWS-L), a score that better predicts outcomes in the geriatric population was developed (7). The Modified Early Warning Score (MEWS) is one of the triage scoring methods used to identify patients in need of intensive and critical care, and to expedite their transfer to the intensive care unit. It evaluates systolic blood pressure, heart rate, respiratory rate, body temperature, and neurological status. MEWS is included in routine nursing care procedures in some countries and is routinely assessed by nurses. ICU admission rates and mortality rates increase for those who score 5 or more on this scale, although this threshold may vary in different populations or clinical situations. In a Korean study analyzing sepsis patients, combining lactate with the MEWS score improved the prediction of the need for intensive care (8). The National Early Warning Score (NEWS) is another scoring system used to determine clinical deterioration and follow-up level for all hospitalized patients, as well as to predict clinically high-risk patients. It is calculated by evaluating respiratory rate, oxygen saturation, oxygen support status, blood pressure, body temperature, and neurological status. The NEWS-L score, obtained by combining NEWS with lactate, has been reported to be superior to NEWS alone in geriatric critically ill patients (9). However, contrary to the geriatric patient study, Özkan's study reported that NEWS-L was not superior to NEWS and that they exhibited similar predictive abilities (10). As a result, researchers are actively working on new parameters and scoring systems to optimize resource utilization and predict critical illness. Researchers should be encouraged to investigate studies on EWS lactate combinations or other combinations.
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Perera, Yashasvi Sanja, Priyanga Ranasinghe, Adikari Mudiyanselage Madura Adikari, et al. "The value of the Modified Early Warning Score and biochemical parameters as predictors of patient outcome in acute medical admissions: a prospective study." Acute Medicine Journal 10, no. 3 (2011): 126–32. http://dx.doi.org/10.52964/amja.0491.
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Abstract We evaluated the effectiveness of MEWS and biochemical parameters in predicting outcomes for acute medical admissions. Data from consecutive admissions to the Acute Medical Unit (AMU) of National Hospital of Sri Lanka were collected. C-reactive protein (CRP), albumin, white cell count, platelet count and haemoglobin values were collected. Adverse endpoints were HDU/ICU admission, cardio-respiratory emergency/resuscitation and death. A MEWS score of >=5 together with increasing age, pulse rate, respiratory rate, AVPU score, CRP, CRP/Albumin ratio and reduced platelet and albumin level all increased the odds of reaching ‘adverse endpoints”. Adding a score for biochemical parameters increased the area under the ROC curve for reaching “adverse endpoints’. Biochemical parameters better predicted length of hospitalstay and adverse outcomes. A combined scoring system improved the sensitivity of prediction.
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Siti Sulaiha, Ima Nadatien, and Eppy Setiyowati. "Modification of the National Early Warning Score (NEWS) Observation Sheet for Patient Emergency Conditions in Hospitals." Journal Of Nursing Practice 8, no. 1 (2024): 119–30. http://dx.doi.org/10.30994/jnp.v8i1.452.
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Background: Currently, the trend of patients admitted to the hospital is increasingly complex and has many co-morbidities, some of which the patient's condition will suddenly worsen or become critical, due to various interrelated causes such as weak monitoring systems and staff reactions to emergencies. Delays in treatment or inadequate care for patients who are treated in the Hospital Ward can result in several adverse conditions, namely increased patients transferred to the ICU (Intensive Care Unit), increased LOS (Lenght of Stay) in the hospital, heart attacks, or patient death. Purpose: The purpose of this study to analyze the differences in the modification of the NEWS observation sheet on the emergency conditions of patients at the hospital. Methods: The type of research used is quasi-experimental with a pre-test-post-test control group design. With a population of 160 patients and a total patient sample of 62 patients with 31 patients for the intervention group and 31 patients for the control group. How to take samples with purposive sampling technique. The independent variables in this study were the NEWS observation sheet and the NEWS modification, while the dependent variable was the patient's emergency condition. The instruments in this study were NEWS observation sheets and NEWS modifications, integrated patient development record sheets, pre-test and post-test sheets. Data analysis used Wilcoxon test and Mann Whitney test with a value of α = 0.05. Results: The results showed that the modification of the NEWS (National Early Warning Score) observation sheet with a graphic was more influential than the NEWS observation sheet in increasing vital sign monitoring with p=0.00, while the NEWS observation sheet as a control had an influence with a significant level of p=0.043, both the model shows that it is equally influential in detecting changes in patient conditions and as an aid in communicating with other health workers. Conclusion: The conclusion of this study is that after being given a modified NEWS observation sheet which is a scoring system that is simple, practical and proven to increase alertness and response to signs of bad physiological changes so that patient safety can be monitored optimally and mortality rates can decrease.
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Pimentel, Marco A. F., Alistair Johnson, Julie Lorraine Darbyshire, et al. "Development of an enhanced scoring system to predict ICU readmission or in-hospital death within 24 hours using routine patient data from two NHS Foundation Trusts." BMJ Open 14, no. 4 (2024): e074604. http://dx.doi.org/10.1136/bmjopen-2023-074604.
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RationaleIntensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored by nursing staff, with Early Warning Score (EWS) systems being used to identify those at risk of deterioration.ObjectivesWe report the development and validation of an enhanced continuous scoring system for predicting adverse events, which combines vital signs measured routinely on acute care wards (as used by most EWS systems) with a risk score of a future adverse event calculated on discharge from the ICU.DesignA modified Delphi process identified candidate variables commonly available in electronic records as the basis for a ‘static’ score of the patient’s condition immediately after discharge from the ICU. L1-regularised logistic regression was used to estimate the in-hospital risk of future adverse event. We then constructed a model of physiological normality using vital sign data from the day of hospital discharge. This is combined with the static score and used continuously to quantify and update the patient’s risk of deterioration throughout their hospital stay.SettingData from two National Health Service Foundation Trusts (UK) were used to develop and (externally) validate the model.ParticipantsA total of 12 394 vital sign measurements were acquired from 273 patients after ICU discharge for the development set, and 4831 from 136 patients in the validation cohort.ResultsOutcome validation of our model yielded an area under the receiver operating characteristic curve of 0.724 for predicting ICU readmission or in-hospital death within 24 hours. It showed an improved performance with respect to other competitive risk scoring systems, including the National EWS (0.653).ConclusionsWe showed that a scoring system incorporating data from a patient’s stay in the ICU has better performance than commonly used EWS systems based on vital signs alone.Trial registration numberISRCTN32008295.
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Mitsunaga, Toshiya, Izumu Hasegawa, Masahiko Uzura, et al. "Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department." PeerJ 7 (May 16, 2019): e6947. http://dx.doi.org/10.7717/peerj.6947.
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The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.
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Vishagan S, Abhi, J. Sridhar, Dinesh Kumar, and Vangala Manohar Reddy. "Evaluation of Enhanced Recovery After Surgery (ERAS) Components in Hemodynamically Stable Subjects Undergoing Emergency Abdominal Surgery in VMKVMCH." Journal of Neonatal Surgery 14, no. 6S (2025): 108–17. https://doi.org/10.52783/jns.v14.2194.
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Introduction and Objectives- Intestinal obstructions and perforations are common acute abdominal conditions seen in our emergency department, carrying significant risks if not promptly treated. Implementing Enhanced Recovery After Surgery (ERAS) protocols in this context offers potential for reducing surgical stress response. To study on the evaluation of ERAS components in hemodynamically stable subjects undertaking Emergency abdominal surgery in a 30 care hospital. Methodology: The study was a descriptive study done among 30 subjects with the main objective to study on the evaluation of ERAS components in hemodynamically stable subjects undertaking Emergency abdominal surgery in a 30 care hospital. The study included haemodynamically stable subjects requiring emergency abdominal surgeries and National Early Warning Score (NEWS) scoring-Mild to moderate. Subjects with elective gastrointestinal surgeries, haemodynamically unstable patient, Subjects not willing for surgery and NEWS scoring high risk- aggregate score>7. The subjects were assessed with preoperative, intraoperative and post operative ERAS protocols. The data was inputted into Microsoft Excel and analyzed utilizing SPSS 23. Results: All the subjects had Patient, Family Education and Shared Decision, early imaging, anti-microbial prophylaxis, preoperative pain medication, nasogastric intubation, open surgical access, goal directed fluid therapy, warm IV fluids, non-opioid analgesia, received Ondansetron 4 mg iv as Post Operative Nausea and Vomiting(PONV), Post- Operative Analgesia, Thromboprophylaxis, Net Zero Fluid And Electrolyte Balance, Glycaemic Control and Sham Feeding. Among the subjects, 27 (90%) had quick Sequential Organ Failure Assessment (qSOFA) score 1 and 3 (10%) had qSOFA score 2. Among the subjects, 29 (96.67%) had score 0 and 1 (3.33%) had score 1.5 as Modified Wells Score for Venous Thrombo-embolism. Among the subjects, 6 (20%) received Fresh Frozen Plasma (FFP) Transfusion and remaining 24 (80%) received no anti thrombotic medication. Conclusion: This study showed a significant alteration in management on the basis of preoperative, intraoperative and postoperative protocols by ERAS. When applied to trauma laparotomy, which involves surgical exploration of the abdomen due to traumatic injuries, implementing ERAS protocols has been demonstrated to have beneficial effects
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Rutvik, K. Shukla*1 &. Dr Chetan B. Bhatt 2. "COMMONKADS MODEL FRAMEWORK FOR WEB-BASED EMERGENCY MEDICINE DECISION SUPPORT SYSTEM." GLOBAL JOURNAL OF ENGINEERING SCIENCE AND RESEARCHES 5, no. 9 (2018): 306–12. https://doi.org/10.5281/zenodo.1441322.
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Medical decision support system proves one of the most significant usages of Decision Support System (DSS) and ICT (Information and Communication Technology) in the health care domain. Providing medical support and facilities in the rural area is the critical issue in the developing countries, like India. Most of the existing technology focused on providing offline telemedicine approach, which will not be handy for emergency purpose. Other approaches focus on providing offline guidance to the emergency paramedics without actually looking at the patient real time vital parameters. This web-based emergency support system will exhibit reasonable accuracy in predicting patient’s risk level and forecasting possible disease with onsite suggestion for treatment. Most of the existing solutions are system specific and their applicability is also limited to the mentioned field. They all are utilizing some specific algorithm design based on some predefined rule base. These methodologies lack the ability to scale up and to support the development of large DSS. The modelling approach for creating Knowledge Base Systems (KBS) is much more popular due to its modular structure and its capability to split the knowledge engineering problem into smaller tasks. Different methodologies are proposed by the different researcher for modeling knowledge-based system. Common KADS is considered to be one of the most popular methods amongst them. This paper incorporates all the different models of Common KADS for emergency medicine DSS. The proposed system includes clinical risk detection, disease prediction and suggesting possible treatment as well.
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Luís, Leandro, and Carla Nunes. "Short National Early Warning Score — Developing a Modified Early Warning Score." Australian Critical Care 31, no. 6 (2018): 376–81. http://dx.doi.org/10.1016/j.aucc.2017.11.004.
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Al-Dmour, Jumanah A., Assim Sagahyroon, AR Al-Ali, and Salah Abusnana. "A fuzzy logic–based warning system for patients classification." Health Informatics Journal 25, no. 3 (2017): 1004–24. http://dx.doi.org/10.1177/1460458217735674.
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Typically acute deterioration in sick people is preceded by subtle changes in the physiological parameters such as pulse and blood pressure. The Modified Early Warning Score is a scoring system developed to assist hospital staff in gauging these physiological changes and identifying patients in need of urgent medical care to avoid catastrophic deterioration. This work discusses the design and implementation of an equivalent warning system that utilizes fuzzy logic techniques to categorize patients’ status. The system is implemented and tested in Rashid Centre for Diabetes and Research in UAE. Results are compared with those obtained using the Modified Early Warning System that is currently used in practice. We demonstrate that the implemented system provides reliable results that are in agreement with the current Modified Early Warning Score system, with the added benefit of a scoring scheme that provides a better insight into the status or medical condition of each patient.
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Yuan, Wang Chang, Cao Tao, Zhu Dan Dan, Sun Chang Yi, Wang Jing, and Qin Jian. "The significance of National Early Warning Score for predicting prognosis and evaluating conditions of patients in resuscitation room." Hong Kong Journal of Emergency Medicine 25, no. 6 (2018): 324–30. http://dx.doi.org/10.1177/1024907918775879.
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Background: For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II. Objectives: To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms. Methods: A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality. Results: For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group ( p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 ( p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant ( p < 0.05). Conclusion: The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room.
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Sharma, Dr Parul, Avantika Kaundal, and Sonal Rai. "Modified Early Warning Score (MEWS)." INTERANTIONAL JOURNAL OF SCIENTIFIC RESEARCH IN ENGINEERING AND MANAGEMENT 08, no. 12 (2024): 1–7. https://doi.org/10.55041/ijsrem40125.
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The Modified Early Warning Score (MEWS) is a healthcare tool that helps identify people who are at risk of major medical problems. MEWS enables healthcare practitioners to detect signs of deterioration early by monitoring important physiological markers such as heart rate, respiration rate, blood pressure, body temperature, and state of consciousness. This allows for quick medical action, which can reduce problems, improve patient outcomes, and even save lives. MEWS uses a scoring system, with higher scores indicating a greater probability of clinical decline. Abnormal heart rates, irregular breathing patterns, low or high blood pressure, odd body temperature, or changes in a patient's state of alertness can all contribute to an elevated MEWS score. When a specific threshold is achieved, the system alerts workers to take action, such as contacting a specialist or moving the patient to a higher degree of care. such as the intensive care unit (ICU). This procedure guarantees that severely ill patients receive treatment before their condition becomes life-threatening. This approach is commonly used in hospital wards and emergency rooms since it is simple, straightforward to execute, and does not necessitate advanced equipment. According to studies, MEWS is helpful in predicting bad outcomes such as the requirement for ICU admission or the probability of death in the hospital. It also allows healthcare teams to more efficiently manage resources by prioritising patients who require immediate attention. For example, in crowded hospitals with limited staff and equipment, MEWS can identify which patients require critical care the most, guaranteeing that no one is ignored. Despite the benefits, deploying MEWS in healthcare settings presents problems. One major concern is ensuring that all staff members have been properly educated to utilise the product. Misinterpretation of ratings or delays in taking action can limit their efficacy. Additionally, hospitals must create clear processes for responding to various MEWS thresholds. Without regular commitment to these rules, MEWS's full potential may not be realised. Regular staff training and system evaluations are critical for addressing these issues and improving the tool's reliability. MEWS has had a substantial influence on patient care by making it easier for healthcare personnel to detect when a patient's condition worsens. It acts as an early warning system, reducing the likelihood of unexpected emergencies and allowing medical teams to provide proactive care. While there are certain areas for development, such as improved training and stricter protocol adherence, the benefits of MEWS in terms of patient safety and outcomes are apparent. It is an important instrument in modern healthcare, saving lives and maximising hospital resources. Keywords: Vital Signs Assessment, Clinical Monitoring, and Patient Safety
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Vilaça, Luana Vilela, Suzel Regina Ribeiro Chavaglia, Fabiana Cristina Pires Bernardinelli, Ingrid Fidelix de Souza, Caroline Bueno de Moraes Pereira, and Sheila Aparecida da Silva da Silva. "Escalas de alerta precoce para rastrear deterioração clínica em serviços médicos de emergência: revisão integrativa." Enfermería Global 21, no. 4 (2022): 587–637. http://dx.doi.org/10.6018/eglobal.502451.
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Objective: To identify the scientific evidence in the literature on the use of early warning scales in the identification of adult and elderly patients in clinical deterioration in emergency medical services.Methods: Integrative review, supported by the recommendation Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a search mnemonic based on the Populacion - Interest Phenomenon - Context (PICo) strategy, performed in the sources: US National Library of Medicine National Institutes Database Search of Health, Web of Science, SciVerse Scopus, Latin American and Caribbean Literature in Health Sciences and Cumulative Index to Nursing and Allied Health Literature. Rayyan was used in selection and content analysis to analyze the findings.Results: 691 articles were identified, of which 22 composed the sample and 27 scales were listed, with emphasis on the National Early Warning Score, National Early Warning Score 2, Quick Sepsis Related Organ Failure Assessment and Modified Early Warning Score. The scales had similar assessment parameters, characterized by heart rate, respiratory rate, systolic blood pressure, temperature, oxygen saturation and level of consciousness.Conclusion: 27 scales were listed with similar evaluation parameters, in which four were the most prevalent and of these the National Early Warning Score proved to be the most accurate, however evidence shows that the Modified Early Warning Score is the most used in emergency medical services. Objetivo: Identificar la evidencia científica en la literatura sobre el uso de escalas de alerta temprana en la identificación de pacientes adultos y ancianos en deterioro clínico en servicios médicos de emergencia.Métodos: Revisión integradora, apoyada por la recomendación Preferred Reporting Items for Systematic Reviews and Meta-Analyses, con una estrategia de búsqueda basada en la mnemotécnica Población - Fenómeno de interés - Contexto (PICo), realizada en las fuentes: US National Library of Medicine National Institutes Database Search of Health, Web of Science, SciVerse Scopus, Literatura Latino-americana e do Caribe em Ciências da Saúde e Cumulative Index to Nursing and Allied Health Literature. Rayyan se utilizó en la selección y el análisis de contenido para analizar los hallazgos.Resultados: Se identificaron 691 artículos, de los cuales 22 compusieron la muestra y se enumeraron 27 escalas, National Early Warning Score, National Early Warning Score 2, Quick Sepsis Related Organ Failure Assessment e Modified Early Warning Score. Las escalas tenían parámetros de evaluación similares, caracterizados por frecuencia cardíaca, frecuencia respiratoria, presión arterial sistólica, temperatura, saturación de oxígeno y nivel de conciencia.Conclusión: Se enumeraron 27 escalas con parámetros de evaluación similares, en las cuales cuatro fueron las más prevalentes y de estas la National Early Warning Score resultó ser la más precisa, sin embargo, la evidencia muestra que la Modified Early Warning Score es la más utilizada en servicios médicos de emergencia. Objetivo: Identificar as evidências científicas existentes na literatura sobre o uso de escalas de alerta precoce na identificação de pacientes adultos e idosos em deterioração clínica nos serviços médicos de emergência.Métodos: Revisão integrativa sustentada pela recomendação Preferred Reporting Items for Systematic Reviews and Meta-Analyses, com estratégia de busca fundamentada no mnemônico Populacion - Interest Phenomenon - Context (PICo), realizada nas fontes: US National Library of Medicine National Institutes Database Search of Health, Web of Science, SciVerse Scopus, Literatura Latino-americana e do Caribe em Ciências da Saúde e Cumulative Index to Nursing and Allied Health Literature. Utilizou-se o Rayyan na seleção e a análise de conteúdo para análise dos achados.Resultados: Identificaram-se 691 artigos, destes, 22 compuseram a amostra e elencaram-se 27 escalas, com destaque para a National Early Warning Score, National Early Warning Score 2, Quick Sepsis Related Organ Failure Assessment e Modified Early Warning Score. As escalas possuíam parâmetros de avaliação semelhantes, caracterizados pela frequência cardíaca, frequência respiratória, pressão arterial sistólica, temperatura, saturação de oxigênio e nível de consciência.Conclusão: Elencaram-se 27 escalas com parâmetros de avaliação semelhantes, das quais quatro foram as mais prevalentes e, destas, a National Early Warning Score demonstrou ser a mais precisa. No entanto, as evidências demonstram que a Modified Early Warning Score é a mais utilizada nos serviços médicos de emergência.
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Kim, Taehwa, Yunwon Tae, Hye Ju Yeo, et al. "Development and Validation of Deep-Learning-Based Sepsis and Septic Shock Early Prediction System (DeepSEPS) Using Real-World ICU Data." Journal of Clinical Medicine 12, no. 22 (2023): 7156. http://dx.doi.org/10.3390/jcm12227156.
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Background: Successful sepsis treatment depends on early diagnosis. We aimed to develop and validate a system to predict sepsis and septic shock in real time using deep learning. Methods: Clinical data were retrospectively collected from electronic medical records (EMRs). Data from 2010 to 2019 were used as development data, and data from 2020 to 2021 were used as validation data. The collected EMRs consisted of eight vital signs, 13 laboratory data points, and three demographic information items. We validated the deep-learning-based sepsis and septic shock early prediction system (DeepSEPS) using the validation datasets and compared our system with other traditional early warning scoring systems, such as the national early warning score, sequential organ failure assessment (SOFA), and quick sequential organ failure assessment. Results: DeepSEPS achieved even higher area under receiver operating characteristic curve (AUROC) values (0.7888 and 0.8494 for sepsis and septic shock, respectively) than SOFA. The prediction performance of traditional scoring systems was enhanced because the early prediction time point was close to the onset time of sepsis; however, the DeepSEPS scoring system consistently outperformed all conventional scoring systems at all time points. Furthermore, at the time of onset of sepsis and septic shock, DeepSEPS showed the highest AUROC (0.9346). Conclusions: The sepsis and septic shock early warning system developed in this study exhibited a performance that is worth considering when predicting sepsis and septic shock compared to other traditional early warning scoring systems. DeepSEPS showed better performance than existing sepsis prediction programs. This novel real-time system that simultaneously predicts sepsis and septic shock requires further validation.
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Carmichael, H. A., E. Robertson, J. Austin, D. Mccruden, C. M. Messow, and P. R. Belcher. "A new approach to scoring systems to improve identification of acute medical admissions that will require critical care." Scottish Medical Journal 56, no. 4 (2011): 195–202. http://dx.doi.org/10.1258/smj.2011.011157.
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Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92.4%) than PREAMBLE-1 (88.1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.
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Suhr, Kelsey, Cyndy Steen, and Robin Thompson. "Early Intervention Using the National Early Warning Scoring System for Hematological Mallignancy and HSCT Patients." Biology of Blood and Marrow Transplantation 26, no. 3 (2020): S385. http://dx.doi.org/10.1016/j.bbmt.2019.12.143.
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Zhou, Xianshi, Ye Ye, and Guanghua Tang. "Clinical study of a new Modified Early Warning System scoring system, some lingering doubts." Journal of Critical Care 40 (August 2017): 303–4. http://dx.doi.org/10.1016/j.jcrc.2017.05.032.
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Ping Kirk, Angela Hui, Yee Hui Mok, Rehena Sultana, et al. "685: EVALUATION OF A MODIFIED PEDIATRIC EARLY WARNING SCORING SYSTEM: A SINGLE-CENTER STUDY." Critical Care Medicine 52, no. 1 (2023): S315. http://dx.doi.org/10.1097/01.ccm.0001000912.31754.8e.
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Valiollahzadeh, Saeedehsadat, Ali Ostadi, and Farzad Rahmani. "Predictive Value of National Early Warning Score and Modified Early Warning Score in Outcome of Patients With Poisoning." International Journal of Medical Toxicology and Forensic Medicine 12, no. 4 (2022): 38299. http://dx.doi.org/10.32598/ijmtfm.v12i4.38299.
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Background: Using different scores to predict the outcome of patients and determine the severity of their illness could be effective in making better clinical decisions and helping patients. The purpose of this study is to determine the predictive value of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) of in-hospital mortality in patients with a suicide attempt. Methods: In a diagnostic study, we included 453 patients with suicide attempts in the poisoning unit and Intensive Care Unit (ICU) poisoning unit of Sina Hospital from December 2019 to September 2021. Patients’ vital signs and level of consciousness were recorded and then analyzed by statistical methods. Results: The Mean±SD of patients’ age was 31.82±12.28 and the mortality rate was 7.7%. The median (25%-75%) of NEWS and MEWS in all patients was 4(2-7) and 2(1-3), respectively. Based on the Receiver Operating Characteristic (ROC) curve of NEWS, the Area Under The Curve (AUC) (CI95%), standard error, and cut off point were 0.915(0.876-0.995), 0.020, and 7.5 respectively (85% sensitivity and 81% specificity) (P˂0.001). The results of MEWS based on Receiver Operating Characteristic (ROC) curve were 0.87 (0.805-0.932), 0.033, and 3.5 respectively (74% sensitivity and 84% specificity) (P˂0.001). Conclusion: Based on our study results, we concluded that in hospitalized patients with suicide attempts, the accuracy of NEWS in predicting hospital mortality is higher than MEWS
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Pang, Zehui, Meili Ma, Chenfei Qu, Chunlin Liu, and Xia Sheng. "The Latest Research Progress in the Application of MEWS Scoring System in Clinical Nursing." Journal of Clinical and Nursing Research 7, no. 2 (2023): 1–7. http://dx.doi.org/10.26689/jcnr.v7i2.4689.
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This paper summarizes the background of the formation of the Modified Early Warning System (MEWS) evaluation system, its current status of clinical teaching applications in different fields of hospitals, and its significance on the medical and nursing career, aiming to provide specific theoretical basis for medical staff and lay a foundation for continuing to carry out related work on MEWS.
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Poudyal, S., and YP Singh. "Early warning score in predicting the severity of acute pancreatitis." Journal of Society of Surgeons of Nepal 17, no. 1 (2016): 16–20. http://dx.doi.org/10.3126/jssn.v17i1.15176.
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Introduction: Acute Pancreatitisis leading causes of morbidity and mortality worldwide. A third of patientsdevelop severe pancreatitis with progressive organ dysfunction caused by systemic inflammatory response syndrome.Early identification of severe pancreatitis is essential for proper care and preventing complications. Various scoring systems have been developed to determine the severity.An ideal prognostic marker would be that is easily measurable, reproducible and cost effective. Early Warning Score is a simple physiological scoring system that can be reliably measured at the patient’s bedside. This study was aimed to determine the relationship between early warning score and severity of pancreatitis.Methods: Patients admitted with diagnosis of acute pancreatitis were included. Early warning score was calculated four hourly for 72 hours. Modified Marshall Score was determined at admission and at 48 hours. Severity of acute pancreatitis as defined by revised Atlanta Classification. EWS was correlated with severity of AP. EWS≥3 for more than 48 hours were regarded as severe pancreatitis and EWS≥3 at any time was regarded as a predictor of severe pancreatitis.Results: Eighty-six patients were included with 24 (27.9%) with severe pancreatitis. The sensitivity, specificity,positive andnegative predictive valueof EWS≥3 persistent for 48 hours or more in predicting severity were 87.5%, 98.38%, 95.45% and 95.31% respectively. Correlation between EWS and severity of pancreatitis was statistically significant.Conclusion: EWS is useful as an easy and reliable prognostic marker of the evolution and complications of acute pancreatitis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 16-20
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Tagliabue, Fabio, Daniele Schena, Luca Galassi, et al. "Modified National Early Warning Score as Early Predictor of Outcome in COVID-19 Pandemic." SN Comprehensive Clinical Medicine 3, no. 9 (2021): 1863–69. http://dx.doi.org/10.1007/s42399-021-00997-y.
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Neary, Peter M., Mark Regan, Myles J. Joyce, Oliver J. McAnena, and Ian Callanan. "National early warning score (NEWS) – evaluation in surgery." International Journal of Health Care Quality Assurance 28, no. 3 (2015): 245–52. http://dx.doi.org/10.1108/ijhcqa-01-2014-0012.
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Purpose – The purpose of this paper is to evaluate staff opinion on the impact of the National Early Warning Score (NEWS) system on surgical wards. In 2012, the NEWS system was introduced to Irish hospitals on a phased basis as part of a national clinical programme in acute care. Design/methodology/approach – A modified established questionnaire was given to surgical nursing staff, surgical registrars, surgical senior house officers and surgical interns for completion six months following the introduction of the NEWS system into an Irish university hospital. Findings – Amongst the registrars, 89 per cent were unsure if the NEWS system would improve patient care. Less than half of staff felt consultants and surgical registrars supported the NEWS system. Staff felt the NEWS did not correlate well clinically with patients within the first 24 hours (Day zero) post-operatively. Furthermore, 78-85 per cent of nurses and registrars felt a rapid response team should be part of the escalation protocol. Research limitations/implications – Senior medical staff were not convinced that the NEWS system may improve patient care. Appropriate audit proving a beneficial impact of the NEWS system on patient outcome may be essential in gaining support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward. Originality/value – Appropriate audit of the impact of the NEWS system on patient outcome may be pertinent to obtain the support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward.
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Thakur, Indranil, Ashis Ghosh, Sanat Jatua, Debdutta Haldar, Utpal Dan, and Tanmay Panja. "A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome." National Journal of Physiology, Pharmacy and Pharmacology 13, no. 9 (2023): 1. http://dx.doi.org/10.5455/njppp.2023.13.12617202217012023.
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Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Materials and Methods: An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Results: The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings howed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion: We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.
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Stolić, Radojica, Dragica Bukumirić, Milena Jovanović, et al. "A new scoring system for Covid-19 in patients on hemodialysis: Modified Early Warning score." Praxis medica 50, no. 1-2 (2021): 1–6. http://dx.doi.org/10.5937/pramed2102001s.
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Introduction. At the very beginning of the Corona virus epidemic there was not enough data on whether hemodialysis patients have a higher risk for Corona virus infection and which factors may affect the severity of clinical picture. Objective. The aim of the study was to determine the significance of the Modified Early Warning Assessment (MEWS) score for the assessment of coronavirus disease exacerbation. Methods. The research was conducted in COVID dialysis, as a retrospective, descriptive-analytical study, at the University Clinical Center Kragujevac, Serbia, which was organized ad-hoc for treatment of SARS-Cov-2 infection positive patients, which are transfered from Center for Hemodialysis "Ćuprija". They were evaluated routine laboratory findings, demographic and gender structure, arterial blood pressure, presence of comorbidities and residual diuresis, duration of dialysis, radiological evaluation of lungs, determination of MEWS score were the parameters that were monitored. The results were monitored on admission and and in the end of treatment. Results. A statistically significant difference was registered in serum lactate dehydrogenase concentration (486 ± 107.62 vs. 423.7 ± 92.4 U/L); p = 0.022 and absolute monocyte count (0.46 ± 0.15 vs. 0.67 ± 0.34 x 103; p = 0.008). The significant increase in MEWS score was also found (b = 0.017; p = 0.030). There was a positive correlation between increase of MEWS score and age (b = 0.027; p = 0.002) and arterial hypertension as a concomitant comorbidity (b = 0.700; p = 0.033). Conclusion. In the observed period, there was a significant increase in the degree of MEWS score of dialysis patients who had SARS-Cov-2 infection.
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Molugu, C., W. Falconer, A. Singer, et al. "P246 CURBO2–65 Has Better Correlation than CURB65 with Modified Early Warning Scoring System (MEWS)." Thorax 68, Suppl 3 (2013): A188.2—A189. http://dx.doi.org/10.1136/thoraxjnl-2013-204457.398.
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Quarterman, C. P. J., A. N. Thomas, M. McKenna, and R. McNamee. "Use of a patient information system to audit the introduction of modified early warning scoring." Journal of Evaluation in Clinical Practice 11, no. 2 (2005): 133–38. http://dx.doi.org/10.1111/j.1365-2753.2005.00513.x.
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Durantez-Fernández, Carlos, Begoña Polonio-López, José L. Martín-Conty, et al. "Comparison of Nine Early Warning Scores for Identification of Short-Term Mortality in Acute Neurological Disease in Emergency Department." Journal of Personalized Medicine 12, no. 4 (2022): 630. http://dx.doi.org/10.3390/jpm12040630.
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(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS [Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS)] upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment.
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Mallela, Abraham Paul. "Recognizing sepsis early: A proposed National Early Warning Score-based approach for Indian emergency practice." Medicover Journal of Medicine 2, no. 1 (2025): 4–8. https://doi.org/10.4103/mjm.mjm_7_25.
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Early identification and intervention in clinical deterioration are crucial in emergency medicine. Early warning scores (EWSs), particularly the national EWS 2 (NEWS2) and pediatric EWS (PEWS), have become essential tools in recognizing acutely unwell patients. To evaluate the implementation and clinical value of NEWS2 and PEWS in the emergency department (ED), with a focus on their role in early sepsis detection and escalation pathways. A narrative review was conducted examining current guidelines, hospital protocols, and the integration of NEWS2/PEWS in digital workflows. Particular attention was paid to how these scoring systems interface with sepsis alert pathways. NEWS2 uses six physiological parameters and has become standardized across NHS trusts. A score of ≥5 or a score of 3 in any one parameter prompts clinical review, with further escalation thresholds integrated into most ED protocols. In cases of suspected sepsis, NEWS2 ≥5 acts as a critical trigger, guiding Red Flag and Amber Flag assessments. PEWS, meanwhile, provides age-specific alerts for pediatric patients. Digital integration of EWS into ED systems enhances response time, facilitates communication, and promotes standardization. NEWS2 is instrumental in recognizing deteriorating patients, particularly those with sepsis, ensuring timely escalation and intervention. Their ongoing optimization and digital enhancement are vital to improving emergency care delivery.
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Phillips, Anne-Marie. "Use of the National Early Warning Score in community nursing: a scoping review." British Journal of Community Nursing 26, no. 8 (2021): 396–404. http://dx.doi.org/10.12968/bjcn.2021.26.8.396.
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People in the UK are living longer and with multi-morbidities, increasing the size, complexity and acuity of Community Nursing caseloads. Nurses visiting infrequently and inconsistently on a task-focused basis need an objective method by which to identify / quantify physical deterioration for early treatment avoiding crisis and hospital admission. The National Early Warning Score (NEWS), is the most recognised tool for identification of deterioration in acute settings but is not validated for community use. Using published frameworks for scoping review and evaluation, this study aims to explore the current evidence for use of NEWS in community settings. Although there is work to be done, particularly in terms of frequency of scoring and response, this study identifies benefits in communication and prioritisation of care as well as sensitivity, particularly in predicting poor outcomes. The identified barriers to use include integration into practice and perceived dissonance with clinical judgement.
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Steen, Cyndy. "Extra! Extra! Read All About It! News: National Early Warning Scoring System in BMT Patients." Biology of Blood and Marrow Transplantation 24, no. 3 (2018): S454—S455. http://dx.doi.org/10.1016/j.bbmt.2017.12.737.
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Dr., Parrakal Satish Chandra Menon. "DEVELOPMENT OF AN INTELLIGENT E-HEALTHCARE SYSTEM FOR THE DOMESTIC CARE INDUSTRY." Manager - The British Journal of Administrative Management 57, no. 145 (2021): 189–207. https://doi.org/10.5281/zenodo.5993249.
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Colombo, Christopher J., Rhonda E. Colombo, Ryan C. Maves, et al. "Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort." Critical Care Explorations 3, no. 7 (2021): e0474. http://dx.doi.org/10.1097/cce.0000000000000474.
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Bunkenborg, Gitte, Ingrid Poulsen, Karin Samuelson, Steen Ladelund, and Jonas Akeson. "Bedside vital parameters that indicate early deterioration." International Journal of Health Care Quality Assurance 32, no. 1 (2019): 262–72. http://dx.doi.org/10.1108/ijhcqa-10-2017-0206.
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Purpose The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4). Design/methodology/approach This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals. Findings Respiratory rate, heart rate and patient age were significantly (p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also (p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not. Practical implications It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related. Originality/value Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.
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Sharma, Deepika, Yaseen Chouhan, Sakshi Yadav, and Prawal Shrimal. "To compare blood culture positivity with various sepsis scores in sepsis patients presenting to emergency department: An annotated bibliographic review." Santosh University Journal of Health Sciences 10, no. 2 (2024): 308–11. https://doi.org/10.4103/sujhs.sujhs_81_24.
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ABSTRACT Sepsis is a life-threatening condition characterized by organ dysfunction due to an uncontrolled immune response to infection, posing significant challenges in emergency medicine because of its high morbidity and mortality rates. Early diagnosis and intervention are crucial for improving outcomes, and several sepsis scoring systems have been developed to aid in the identification and management of sepsis. This review examines the predictive value and practical application of blood culture positivity in relation to various sepsis scoring systems, including the National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department (ED) Sepsis score, and Sepsis Patient Evaluation in ED score. By comparing these tools, this review aims to provide insights into their effectiveness in guiding clinical decisions in the management of sepsis.
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Aygun, Huseyin, Suna Eraybar, Fatma Ozdemir, and Erol Armagan. "Predictive Value of Modified Early Warning Scoring System for Identifying Critical Patients with Malignancy in Emergency Department." Archives of Iranian Medicine 23, no. 8 (2020): 536–41. http://dx.doi.org/10.34172/aim.2020.56.
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Background: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. Methods: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients’ health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. Results: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%–82.0%) for hospitalization and 76.24% (95% CI 71.5–80.5) for mortality; the specificity was 69.52 (95% CI 62.8–75.7) for hospitalization and 90.65 (95% CI 84.65–94.9) for mortality. Conclusion: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.
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Qin, Qin, Yiqin Xia, and Yu Cao. "Clinical study of a new Modified Early Warning System scoring system for rapidly evaluating shock in adults." Journal of Critical Care 37 (February 2017): 50–55. http://dx.doi.org/10.1016/j.jcrc.2016.08.025.
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Jo, Sion, Taeoh Jeong, Jae Baek Lee, Youngho Jin, Jaechol Yoon, and Boyoung Park. "Validation of modified early warning score using serum lactate level in community-acquired pneumonia patients. The National Early Warning Score–Lactate score." American Journal of Emergency Medicine 34, no. 3 (2016): 536–41. http://dx.doi.org/10.1016/j.ajem.2015.12.067.
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Kim, Dong Ki, Dong Hun Lee, and Byung Kook Lee. "Role of the National Early Warning score and Modified Early Warning score for predicting mortality in geriatric patients with non-traumatic coma." Heliyon 10, no. 6 (2024): e28338. http://dx.doi.org/10.1016/j.heliyon.2024.e28338.
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Khan, Amena, Digvijoy Sarma, Chiranth Gowda, and Gabriel Rodrigues. "The Role of Modified Early Warning Score (MEWS) in the Prognosis of Acute Pancreatitis." Oman Medical Journal 36, no. 3 (2021): e272-e272. http://dx.doi.org/10.5001/omj.2021.72.
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Objectives: Modified Early Warning Score (MEWS) is a reliable, safe, instant, and inexpensive score for prognosticating patients with acute pancreatitis (AP) due to its ability to reflect ongoing changes of the systemic inflammatory response syndrome associated with AP. Our study sought to determine an optimal MEWS value in predicting severity in AP and determine its accuracy in doing so. Methods: Patients diagnosed with AP and admitted to a single institution were analyzed to determine the value of MEWS in identifying severe AP (SAP). The highest MEWS (hMEWS) score for the day and the mean of all the scores of a given day (mMEWS) were determined for each day. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. Results: Two hundred patients were included in the study. The data suggested that an hMEWS value > 2 on day one is most accurate in predicting SAP, with a specificity of 90.8% and PPV of 83.3%. An mMEWS of > 1.2 on day two was the most accurate in predicting SAP, with a sensitivity of 81.2%, specificity of 76.6%, PPV of 69.8%, and NPV of 85.9%. These were found to be more accurate than previous studies. Conclusions: MEWS provides a novel, easy, instant, repeatable, and reliable prognostic score that is comparable, if not superior, to existing scoring systems. However, its true value may lie in its use in resource-limited settings such as primary health care centers.
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Gardner-Thorpe, J., N. Love, J. Wrightson, S. Walsh, and N. Keeling. "The Value of Modified Early Warning Score (MEWS) in Surgical In-Patients: A Prospective Observational Study." Annals of The Royal College of Surgeons of England 88, no. 6 (2006): 571–75. http://dx.doi.org/10.1308/003588406x130615.
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INTRODUCTION The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.
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Itelman, Edward, Gadi Shlomai, Avshalom Leibowitz, et al. "Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study." JMIR Formative Research 6, no. 6 (2022): e36066. http://dx.doi.org/10.2196/36066.
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Background Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a “wish list” score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359
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Yiu, C. J., S. U. Khan, Christian P Subbe, K. Tofeec, and R. A. Madge. "Into the Night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement." Acute Medicine Journal 13, no. 2 (2014): 56–60. http://dx.doi.org/10.52964/amja.0343.
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Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates. Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.