Bedside vital parameters that indicate early deterioration
(2019) In International Journal of Health Care Quality Assurance 32(1). p.262-272- Abstract
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... (More)
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.
(Less)
- author
- Bunkenborg, Gitte LU ; Poulsen, Ingrid LU ; Samuelson, Karin LU ; Ladelund, Steen and Akeson, Jonas LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Association, Clinical deterioration, Early warning score, General ward patients, Vital parameters
- in
- International Journal of Health Care Quality Assurance
- volume
- 32
- issue
- 1
- pages
- 11 pages
- publisher
- Emerald Group Publishing Limited
- external identifiers
-
- pmid:30859885
- scopus:85062765104
- ISSN
- 0952-6862
- DOI
- 10.1108/IJHCQA-10-2017-0206
- language
- English
- LU publication?
- yes
- id
- b703ebce-7eb8-45d3-b811-dda0bec9e204
- date added to LUP
- 2019-03-20 10:36:55
- date last changed
- 2024-08-06 11:58:07
@article{b703ebce-7eb8-45d3-b811-dda0bec9e204, abstract = {{<p>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.</p>}}, author = {{Bunkenborg, Gitte and Poulsen, Ingrid and Samuelson, Karin and Ladelund, Steen and Akeson, Jonas}}, issn = {{0952-6862}}, keywords = {{Association; Clinical deterioration; Early warning score; General ward patients; Vital parameters}}, language = {{eng}}, number = {{1}}, pages = {{262--272}}, publisher = {{Emerald Group Publishing Limited}}, series = {{International Journal of Health Care Quality Assurance}}, title = {{Bedside vital parameters that indicate early deterioration}}, url = {{http://dx.doi.org/10.1108/IJHCQA-10-2017-0206}}, doi = {{10.1108/IJHCQA-10-2017-0206}}, volume = {{32}}, year = {{2019}}, }