TY - JOUR
T1 - Widely used track and trigger scores
T2 - Are they ready for automation in practice?
AU - Romero-Brufau, Santiago
AU - Huddleston, Jeanne M.
AU - Naessens, James M.
AU - Johnson, Matthew G.
AU - Hickman, Joel
AU - Morlan, Bruce W.
AU - Jensen, Jeffrey B.
AU - Caples, Sean M.
AU - Elmer, Jennifer L.
AU - Schmidt, Julie A.
AU - Morgenthaler, Timothy I.
AU - Santrach, Paula J.
N1 - Funding Information:
This study was funded with Mayo Clinic internal funding. The authors graciously thank Megan Reinalda for her assistance with accessing the data sources and creation of the analytic data set necessary for these analyses; and the Morbidity and Mortality Council for their critical review of analytic approach and results.
PY - 2014/4
Y1 - 2014/4
N2 - Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.
AB - Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.
KW - Automation
KW - Cardiorespiratory arrests
KW - Early warning score
KW - Patient safety
KW - Rapid response system
KW - Track-and-trigger
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U2 - 10.1016/j.resuscitation.2013.12.017
DO - 10.1016/j.resuscitation.2013.12.017
M3 - Article
C2 - 24412159
AN - SCOPUS:84895918244
SN - 0300-9572
VL - 85
SP - 549
EP - 552
JO - Resuscitation
JF - Resuscitation
IS - 4
ER -