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Bedside vital parameters that indicate early deterioration

Bunkenborg, Gitte LU ; Poulsen, Ingrid LU ; Samuelson, Karin LU ; Ladelund, Steen and Akeson, Jonas LU (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.

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author
organization
publishing date
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
2019-12-10 07:59:16
@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&lt;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},
  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},
}