vital signs, clinical deterioration, MET calls, acute illness scoring systems (eg. NEWS)

see also:

• Australasian Triage Scale (ATS)

• original NEWS was released in 2012 and has become widely used in UK hospitals
• revised NEWS2 was released Dec 2017 which:
  • revised the chart in line with Resus Council ABCDE sequence
  • added ranges for boundaries of each parameter on chart and removed green to allow for R-G color blind staff
  • new section for SaO2 for patients with hypercapnic resp. failure who have a clinically recommended SaO2 range of 88-92%
  • improved recording of supplemental oxygen and delivery device
• NHS National Early Warning Score (NEWS) 2

• respiratory rate
• oxygen saturation with a 2 point loading if supplemental oxygen needed
• systolic BP
• pulse rate
• level of consciousness (AVPU) or new confusion (hence “ACVPU”)
• temperature

• children aged < 16yrs
• pregnant women
• spinal cord injury

• “Low score” (normal) = aggregate score of 1-4
• urgent clinical review if either:
  • single red score of 3 on any one parameter
  • “Medium score” of 5-6
• emergency clinical review if:
  • “High score” of 7 or more

• in 1999, Stenhouse et al¹⁾ proposed a modification of Morgan's Early Warning Score
• https://www.mdcalc.com/modified-early-warning-score-mews-clinical-deterioration
• includes a revised form of the item for blood pressure, and it is changed from normal blood pressure to urine volume per hour
• parameters:
  • systolic BP
  • HR
  • RR
  • temp
  • AVPU score

• in 1997, Morgan et al created the EWS which was designed solely to secure the timely presence of skilled clinical help by the bedside of those patients exhibiting physiological signs compatible with established or impending critical illness.
• the original EWS was not presented as a predictor of outcome
• parameters: systolic BP, HR, RR, temp, AVPU

• in 1995, Lee et al. introduced a MET in Liverpool Hospital in Australia to provide early screening for and treatment of patients at risk for cardiac arrest
• in 1997, Morgan et al developed the original EWS
• in 1999, the MEWS was developed, initially for surgical patients and then found to be useful for medical admits
• in 1999, Goldhill et al. formed the Patient at Risk Team to respond to patients in the hospital ward who presented with physiological abnormalities, and the number of cases of cardiopulmonary arrest decreased significantly from 30.4 to 3.6 % ²⁾
• in 2001, Buist et al. performed an analysis of MET efficacy and reported that the number of cases of unexpected cardiac arrest decreased by 50 % and that the mortality rate decreased from 77 to 55 % ³⁾
• in 2012, the UK NHS rolled out nationwide use of the NEWS

• Amb Score
  • http://www.acutemedicine.org.uk/wp-content/uploads/2011/10/ala.pdf
  • parameters - 1 point for each:
    • female
    • age < 80
    • access to personal or public transport
    • IV Rx not anticipated
    • not acute confused
    • MEWS = 0
    • not discharged from hospital past 30 days
  • if score ≥ 5 then sensitivity of 92% for predicting discharge within 12 hrs of assessment

• pneumonia:
  • CURB-65
• chronic obstructive pulmonary disease (COPD)
  • DECAF