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

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.

Performance of risk scores in patients with acute exacerbations of COPD / Desempenho de escores de risco em pacientes com exacerbações agudas da DPOC

ABSTRACT Objective: Acute exacerbations of COPD (AECOPD) are common causes of hospitalization. Various scoring systems have been proposed to classify the risk of clinical deterioration or mortality in hospitalized patients with AECOPD. We sought to investigate whether clinical deterioration and mortality scores at admission can predict adverse events occurring during hospitalization and after discharge of patients with AECOPD. Methods: We performed a retrospective study of patients admitted with AECOPD. The National Early Warning Score 2 (NEWS2), the NEWS288-92%, the Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF) score, and the modified DECAF (mDECAF) score were calculated at admission. We assessed the sensitivity, specificity, and overall performance of the scores for the following outcomes: in-hospital mortality; need for invasive mechanical ventilation or noninvasive ventilation (NIV); long hospital stays; hospital readmissions; and future AECOPD. Results: We included 119 patients admitted with AECOPD. The median age was 75 years, and 87.9% were male. The NEWS288-92% was associated with an 8.9% reduction in the number of individuals classified as requiring close, continuous observation, without an increased risk of death in the group of individuals classified as being low-risk patients. The NEWS288-92% and NEWS2 scores were found to be adequate in predicting the need for acute NIV and longer hospital stays. The DECAF and mDECAF scores were found to be better at predicting in-hospital mortality than the NEWS2 and NEWS288-92%. Conclusions: The NEWS288-92% safely reduces the need for clinical monitoring in patients with AECOPD when compared with the NEWS2. The NEWS2 and NEWS288-92% appear to be good predictors of the length of hospital stay and need for NIV, but they do not replace the DECAF and mDECAF scores as predictors of mortality.

RESUMO Objetivo: As exacerbações agudas da DPOC (EADPOC) são causas comuns de hospitalização. Vários escores foram propostos para classificar o risco de deterioração clínica ou mortalidade em pacientes hospitalizados com EADPOC. Buscamos investigar se escores de deterioração clínica e mortalidade no momento da admissão podem prever eventos adversos durante a hospitalização e após a alta de pacientes com EADPOC. Métodos: Realizamos um estudo retrospectivo a respeito de pacientes admitidos com EADPOC. O National Early Warning Score 2 (NEWS2), o NEWS288-92%, o escore Dyspnea, Eosinopenia, Consolidation, Acidemia, and atrial Fibrillation (DECAF, Dispneia, Eosinopenia, Consolidação, Acidemia e Fibrilação atrial) e o escore DECAF modificado (DECAFm) foram calculados no momento da admissão. Avaliamos a sensibilidade, a especificidade e o desempenho geral dos escores quanto aos seguintes desfechos: mortalidade hospitalar; necessidade de ventilação mecânica invasiva ou ventilação não invasiva (VNI); longas internações hospitalares; readmissões hospitalares e futuras AECOPD. Resultados: Incluímos 119 pacientes admitidos com EADPOC. A mediana da idade foi de 75 anos, e 87,9% eram do sexo masculino. O NEWS288-92% associou-se a uma redução de 8,9% no número de indivíduos classificados em pacientes com necessidade de observação atenta e contínua, sem aumento do risco de morte no grupo de indivíduos classificados em pacientes de baixo risco. O NEWS288-92% e o NEWS2 foram considerados adequados para prever a necessidade de VNI aguda e internações hospitalares mais longas. O DECAF e o DECAFm foram considerados melhores em prever a mortalidade hospitalar do que o NEWS2 e o NEWS288-92%. Conclusões: Em comparação com o NEWS2, o NEWS288-92% reduz com segurança a necessidade de monitoramento clínico em pacientes com EADPOC. O NEWS2 e o NEWS288-92% aparentemente são bons preditores do tempo de internação hospitalar e da necessidade de VNI, mas não substituem o DECAF e o DECAFm como preditores de mortalidade.

National Early Warning Score 2 ­ versão brasileira: validade preditiva para adultos com COVID-19* / National Early Warning Score 2 ­ versión brasileña: validez predictiva para adultos con COVID-19 / National Early Warning Score 2 ­ Brazilian version: predictive validity for adults with COVID-19

Objetivo: realizar a validade preditiva do National Early Warning Score 2 ­ versão brasileira (NEWS 2 ­ BR) nos desfechos alta e óbito em pacientes com COVID-19. Método: estudo transversal com análise de validade preditiva. Variáveis sociodemográficas, clínicas, desfechos e os componentes do escore foram coletados em prontuário eletrônico e analisados por meio da estatística descritiva e inferencial. Resultados: incluíram-se 400 pacientes, com mediana de idade de 61 anos. O escore na admissão teve mediana de 5 pontos, com amplitude de 0 a 21. Houve associação entre escores mais altos com o desfecho óbito e escores mais baixos com a alta. A validade preditiva do NEWS 2 ­ BR para o óbito foi realizada pela análise de curva ROC e o ponto de corte de maior acurácia foi de seis pontos. Conclusão: a versão brasileira do NEWS 2 é um escore válido para avaliação de pacientes com COVID-19.

Objective: perform the predictive validity of National Early Warning Score 2 ­ Brazilian version (NEWS 2 ­ BR) in discharge and death outcomes in patients with COVID-19. Method: cross-sectional study with predictive validity analysis. Social-demographical and clinical variables, outcomes and the score components were collected with an electronic health record and analyzed through descriptive and inferential statistics. Outcomes: 400 patients were included, with median age of 61 years. The score, at the moment of admission, had a median of 5 points, with a range from 0 to 21. There is an association between the highest scores and the death outcome and the lowest scores and the discharge outcome. The predictive validity of NEWS 2 ­ BRfor death was established by the analysis of the ROC curve and the most accurate cut-off point was six points. Conclusion: The Brazilian version of NEWS 2 is a valid score to assess patients with COVID-19.

Objetivo: realizar la validez predictiva del National Early Warning Score 2 ­ versión brasileña (NEWS 2 ­ BR) en los resultados alta y fallecimiento en pacientes con COVID-19. Método: estudio transversal con análisis de validez predictiva. Variables sociodemográficas, clínicas, resultados y los componentes del score fueron recolectados en prontuario electrónico y analizados por medio de la estadística descriptiva e inferencial. Resultados: se incluyeron 400 pacientes, con mediana de edad de 61 años. El score en la admisión tuvo mediana de 5 puntos, con amplitud de 0 a 21. Hubo asociación entre scores más altos con el resultado fallecimiento y scores más bajos con el alta. La validez predictiva del NEWS 2 ­ BR para el fallecimiento fue realizada por el análisis de curva ROC y el punto de corte de mayor precisión fue de seis puntos. Conclusión: la versión brasileña del NEWS 2 es un score válido para la evaluación de pacientes con COVID-19.

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica / Desempeño del Sistema de Alerta Precoz Infantil (SAPI) de deterioración clínica / Pediatric Alert Score (EPA) performance in clinical deterioration

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Escores de alerta precoce em pacientes com suspeita ou diagnóstico de sepse: uma revisão integrativa / Early warning scores in patients with suspected or diagnosed sepsis: an integrative review / Puntuaciones de alerta temprana en pacientes con sospecha o diagnóstico de sepsis: una revisión integradora

Objetivo: analisar publicações científicas sobre a utilização de escores de alerta precoce, nos serviços terciários, como ferramentas de detecção da deterioração clínica em paciente com suspeita ou diagnóstico de sepse. Método: revisão integrativa realizada na PubMed, Scopus, Web of Science e Biblioteca Virtual em Saúde entre fevereiro e março de 2021. Incluídos artigos em inglês, espanhol e português, sem delimitação de tempo na busca. Resultados: identificou-se diferentes escores para detecção precoce da deterioração clínica em pacientes com suspeita ou diagnóstico de sepse. As ferramentas mais frequentes nos serviços terciários foram: National Early Warning Score, Sequential Organ Failure Assessment Score e Systemic Inflammatory Response Syndrome (n=6) (50%), sendo a maioria nos Departamentos de Emergências (n=5) (41,6%). Considerações finais: National Early Warning Score foi o escore mais utilizado para pacientes com suspeita ou diagnóstico de sepse com maior acurácia para a predição de mortalidade hospitalar e admissão em Unidade de Terapia Intensiva.

Objective: to examine scientific publications on the use of early warning scores in tertiary services as tools for detecting clinical deterioration in patients with suspected or diagnosed sepsis. Method: this integrative review was conducted in PubMed, Scopus, Web of Science and the Virtual Health Library between February and March 2021. Articles in English, Spanish, and Portuguese were included with no time limits on the search. Results: different scores were found for early detection of clinical deterioration in patients with suspected or diagnosed sepsis. The most frequent tools in tertiary services were the National Early Warning Score, Sequential Organ Failure Assessment Score and Systemic Inflammatory Response Syndrome (n = 6) (50%), most of them in Emergency Departments (n = 5) (41.6 %). Final remarks: the National Early Warning Score was the most used for patients with suspected or diagnosed sepsis and was the most accurate in predicting hospital mortality and admission to the Intensive Care Unit.

Objetivo: analizar publicaciones científicas sobre la utilización de puntuaciones de alerta temprana, en servicios terciarios, como herramientas para detección de deterioro clínico en pacientes con sospecha o diagnóstico de sepsis. Método: revisión integradora en PubMed, Scopus, Web of Science y Biblioteca Virtual en Salud entre febrero y marzo de 2021. Fueron incluidos artículos en inglés, español y portugués, sin límite de tiempo en la búsqueda. Resultados: se identificaron diferentes puntuaciones para detección temprana de deterioro clínico en pacientes con sospecha o diagnóstico de sepsis. Las herramientas frecuentes en los servicios terciarios fueron: National Early Warning Score, Sequential Organ Failure Assessment Score y Systemic Inflammatory Response Syndrome (n=6) (50%), la mayoría en Servicios de Emergencia (n=5) (41,6 %). Consideraciones finales: National Early Warning Score fue la puntuación más utilizada para pacientes con sospecha o diagnóstico de sepsis con mejor precisión para predecir la mortalidad hospitalaria e ingreso a la Unidad de Cuidados Intensivos.

Value of modified early warning score combined with D-dimer test for establishment of an acute pancreatitis severity evaluation model / 中国基层医药

Objective:To investigate the value of modified early warning score (MEWS) combined with D-dimer test in the establishment of an acute pancreatitis severity evaluation model.Methods:The clinical data of 357 patients with acute pancreatitis who received treatment in the Second Affiliated Hospital of Anhui Medical University, China between January 2017 and December 2018 were collected for this study. The receiver operating characteristic curve was used to determine the optimal cut-off value of MEWS combined with D-dimer test for predicting non-mild acute pancreatitis. The relationship between MEWS and D-dimer level was analyzed using regression analysis. The area under the curve (AUC) was used to evaluate the ability of each factor to predict the severity of acute pancreatitis. The sensitivity and specificity of the new model to predict non-mild acute pancreatitis were calculated.Results:According to the receiver operating characteristic curve, the AUC of D-dimer, MEWS, and new model were 0.702, 0.628 and 0.734 respectively ( P < 0.05). The AUC of the new model in predicting non-mild acute pancreatitis was significantly higher than that of MEWS and D-dimer test (0.734 > 0.702 > 0.628, Z = 3.20, P < 0.01). Conclusion:The ability of the new model established based on MEWS and D-dimer to predict the severity of acute pancreatitis is stronger than that of each of MEWS and D-dimer. The new model is simple, convenient and more suitable for clinical use.

Application of pediatric early warning score ruler of children in the nursing of critically ill children in neurology department / 中国实用护理杂志

Objective:To design a pediatric early warning score (PEWS) ruler and observe the effect of its application in the nursing of critically ill children hospitalized in neurology department.Methods:A total of 200 critically ill children admitted to Department of Neurology of Hunan Children′s Hospital from 2018 to 2019. 98 cases who were hospitalized from January to September 2019 were selected as the observation group, and 102 cases who were hospitalized from January to September 2018 were set as the control group. The control group received conventional care, while the observation group conducted PEWS ruler for nursing intervention on the basis of conventional care. The differences in hospital days, ICU transfer rate, and frequency of medical intervention between the two groups were compared.Results:The hospital days of the control group and observation group were 18.17 ± 6.33 and 13.33 ± 6.38 respectively, and the difference between the two groups was significant ( t=5.38, P<0.01). The ICU transfer rate was significantly different between the control group 17.6% (18/102) and observation group 8.2% (8/98) ( χ2=3.98, P<0.05). The reduction of increased intracranial pressure, cooling, calm, sedation and oxygen breathing in the control group were 6.86% (7/102), 13.73% (14/102), 6.86% (7/102), 7.84% (8/102), while the observation group were 17.35% (17/98), 27.55% (27/98), 24.49% (24/98), 28.57% (28/98), and the differences between the two groups were significant ( χ2 values were 5.20-14.55, all P<0.05). Conclusions:The application of PEWS ruler is helpful for nurses to recognize the progress of diseases of the critically ill children. Also, it can shorten the hospitalization days of these children, reduce the ICU transfer rate, as well as improve the nursing quality for them.

Application of modified early warning score in ICU nursing human resource allocation / 中国实用护理杂志

Objective:To explore the application effect of the modified early warning score (MEWS) in the allocation of nursing human resources per shift in ICU.Methods:A total of 470 critically ill patients admitted to the ICU of Xuancheng People′s Hospital from January to December 2019 were selected as the experimental group. In each shift, the nursing leader conducted MEWS score for patients in the ward, and assigned nurses at the corresponding level according to the MEWS score. A total of 346 critically ill patients admitted to ICU from January 2018 to December 2018 were selected as the control group. The head nurse assigned nurses daily according to clinical experience.The incidence of accidental events, nurse error events and medical satisfaction were compared between the two groups.Results:The incidences of accident and nurse error in ICU patients in the experimental group were 5.96% (28/470) and 12.13% (57/470), respectively, which were lower than those in the control group [11.56% (40/346) and 17.92% (62/346)]. The difference between the two groups was statistically significant ( χ2=8.19, 5.37, both P<0.05). The satisfaction degree of the experimental group was 98.63 ± 1.06 and 95.96 ± 1.84, respectively, which were higher than that of the control group 92.13 ± 2.17 and 90.43 ± 2.91, and the difference between the two groups was statistically significant ( t=7.62, 8.56, both P<0.05). Conclusions:Using MEWS score to guide the allocation of nursing human resources in each shift of ICU is helpful to reduce the incidence of accidental events in ICU patients and the incidence of nurses′ errors, ensure patient safety and improve medical satisfaction.

Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study

INTRODUCTION@#The purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET).@*METHODS@#A cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital.@*RESULTS@#A high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05).@*CONCLUSION@#Most physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room / Efecto del national early warning score en el monitoreo de los signos vitales de los pacientes en urgencias / Efeito do national early warning score no monitoramento dos sinais vitais de pacientes no pronto-socorro

ABSTRACT Objective: To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room. Methods: This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression. Results: In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase. Conclusion: The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

RESUMEN Objetivo: Verificar el efecto del uso del sistema National Early Warning Score (NEWS) sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado a pacientes en urgencias. Método: Estudio casi experimental, de tipo antes y después, realizado con 280 pacientes adultos seleccionados por conveniencia en un servicio de urgencias. Con el uso de la regresión lineal se analizó el efecto del NEWS sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el sistema. Resultados: En la fase Pre-NEWS se analizaron 143 pacientes (edad media ± desviación estándar: 54,4 ± 20,5; sexo masculino: 56,6%) y, en la fase Post-NEWS, 137 pacientes (edad media ± desviación estándar: 55,5 ± 20,8; sexo masculino: 50,4%). El 92,6% de los registros de signos vitales después de la adopción de este instrumento presentaron cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el NEWS. Este cumplimiento fue mayor en la fase Post-NEWS con un 9% (p < 0,001). Conclusion: El uso del sistema NEWS tuvo un incremento del cumplimiento de los intervalos de monitoreo de los signos vitales conforme a lo recomendado, pero este cumplimiento disminuyó cuando el puntaje NEWS apuntó a un intervalo más corto en el monitoreo de los signos vitales.

RESUMO Objetivo: Verificar o efeito do uso do sistema National Early Warning Score (NEWS) na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado em pacientes no pronto-socorro. Método: Estudo quasi-experimental, do tipo antes e depois, realizado em um pronto-socorro com 280 pacientes adultos selecionados por conveniência. O efeito do NEWS na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado pelo sistema foi analisado por regressão linear. Resultados: Na fase Pré-NEWS, foram analisados 143 pacientes (idade média ± desvio-padrão: 54,4 ± 20,5; sexo masculino: 56,6%) e, na fase Pós-NEWS, 137 pacientes (idade média ± desvio-padrão: 55,5 ± 20,8; sexo masculino: 50,4%). Houve conformidade do intervalo de monitoramento dos sinais vitais com o recomendo pelo NEWS em 92,6% dos registros de sinais vitais após adoção desse instrumento. Essa conformidade foi maior na fase Pós-NEWS em 9% (p < 0,001). Conclusão: O uso do sistema NEWS aumentou a conformidade dos intervalos de monitorização dos sinais vitais com o recomendado, porém essa conformidade diminuiu quando o escore NEWS apontou para intervalo menor no monitoramento dos sinais vitais.

Comparação dos escores não endoscópicos para a previsão de resultados em doentes com sangramento gastrointestinal alto na emergência de um hospital de referência em cuidados terciários: um estudo de coorte prospectivo / Comparison of non-endoscopic scores for the prediction of outcomes in patients of upper gastrointestinal bleed in an emergency of a tertiary care referral hospital: a prospective cohort study

ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

RESUMO CONTEXTO: Tradicionalmente, a doença úlcera péptica era a causa mais comum de sangramento digestivo alto, mas com a mudança da epidemiologia, outras etiologias do sangramento do trato digestivo alto estão emergindo. Muitas pontuações têm sido descritas para prever resultados e a necessidade de intervenção na hemorragia gastrointestinal superior, mas a comparação prospectiva entre elas é escassa. OBJETIVO: Este estudo foi planeado para determinar o padrão etiológico de pacientes com hemorragia digestiva alta e comparar os escores de Glasgow Blatchford, o Rockall pré-endoscopia, o AIMS65 e o Early Warning modificado (MEWS) como preditores do resultado. MÉTODOS: Neste estudo prospetivo de coorte, 268 pacientes com sangramento digestivo alto foram acompanhados durante 8 semanas. Os escores Glasgow Blatchford, Rockall pré-endoscopia, AIMS65 e MEWS foram calculados para cada paciente, e a área sob a curva (AUC-ROC) para cada pontuação foi comparada. RESULTADOS: A etiologia mais comum para a hemorragia gastrointestinal alta foi varizes gastroesofágicas 150 (63,55%), seguida de úlcera péptica 29 (12,28%) e de doença erosiva de mucosa 27 (11,44%). No total, 38 (15,26%) doentes voltaram a sangrar e 71 (28,5%) doentes morreram. No total, 126 (47%) doentes necessitaram de transfusão de componentes sanguíneos, 25 (9,3%) necessitaram de ventilação mecânica e 2 (0,74%) destes doentes necessitaram de intervenção cirúrgica. O escore de Glasgow Blatchford foi o melhor na previsão da necessidade de transfusão (corte - 10, AUC-ROC =0,678). Enquanto o AIMS65 com uma pontuação de ≥2 foi o melhor na previsão de ressangramento (AUC-ROC =0,626) e mortalidade (AUC-ROC =0,725). CONCLUSÃO: O sangramento gastrointestinal alto mais comum é de origem varicosa em centro de referência terciária. O AIMS65 é o melhor escore simples, com uma pontuação de ≥2 para prever o ressangramento e a mortalidade.

National Early Warning Score 2 Lactate (NEWS2-L) in Predicting Early Clinical Deterioration in Patients with Dyspnoea in Prehospital Care / National Early Warning Score 2 y ácido láctico (NEWS2-L) en la predicción del deterioro clínico precoz en pacientes con disnea en los cuidados prehospitalarios / National Early Warning Score 2 e ácido láctico (NEWS2-L) na predição de deterioração clínica precoce em pacientes com dispneia no atendimento pré-hospitalar

Objective. To evaluate the ability of the NEWS2-L (National Early Warning Score 2 Lactate) scale to predict the risk of early clinical deterioration (mortality within 48 hours) in patients with dyspnoea treated by the Medical Emergency Services compared with NEWS2 and lactate in isolation. Methods. Prospective, multi-centre study of a cohort of 638 patients with dyspnoea treated in the ambulance and priority-transferred to a hospital emergency service in the cities of Valladolid, Salamanca, Segovia or Burgos (Spain). We collected clinical, analytical and demographic data. The main outcome measure was all-cause mortality within 48 hours. The recommendations of the Royal College of Physicians were followed to calculate NEWS2. When NEWS2 and LA prehospital values were obtained, the two values were added together to obtain the NEWS2-L. Results. Mortality within 48 hours was fifty-six patients (8.8%). The NEWS2-L scale obtained an area under the curve (AUC) of the receiver operating characteristics (ROC) for mortality within 48 hours of 0.854 (CI 95% 0.790­0.917), at seven days of 0.788 (CI 95% 0.729­0.848) and at 30 days of 0.744 (CI 95% 0.692­0.796); in all cases p<0.001, with a significant decrease between the value at 48 hours and at 30 days. Conclusion. The NEWS2-L scale was found to be significantly superior to the NEWS2 scale and similar to lactate in predicting early clinical deterioration in patients with dyspnoea. This scale can help a nurse detect these patients early, as part of their regular practice, and thus guide therapeutic efforts.

Objetivo. Evaluar la capacidad de la escala NEWS2-L (National Early Warning Score 2-lactate) para predecir el riesgo de deterioro clínico precoz (mortalidad hasta las 48h) en pacientes con disnea atendidos por Servicios de Emergencias Médicas, comparado con la escala NEWS2 y el ácido láctico en solitario. Métodos. Estudio prospectivo multicéntrico de cohorte de 638 pacientes con disnea atendidos en ambulancia y trasladados con alta prioridad a un servicio de urgencias hospitalarias en las ciudades de Valladolid, Salamanca, Segovia y Burgos (España). Se tomó información de variables clínicas, analíticas y demográficas, de las cuales la de resultado principal fue la mortalidad por cualquier causa hasta las 48 horas. Para el cálculo del NEWS2 se siguieron las recomendaciones del Royal College of Physicians. Una vez obtenidos los valores del NEWS2 y del AL prehospitalario se sumaron ambos valores y se obtuvo la NEWS2-L. Resultados. La mortalidad, antes de las 48, horas fue de 56 pacientes (8.8%). La escala NEWS2-L obtuvo un Área Bajo la Curva ­ Característica Operativa del Receptor (ABC-COR) para la mortalidad antes de las 48 horas de 0.854 (IC95% 0.790-0.917), a siete días de 0.788 (IC95% 0.729-0.848) y a 30 días de 0.744 (IC95% 0.692-0.796); en todos los casos p<0.001), lo que experimentó un descenso importante entre su valor a las 48 h y a los 30 días. Conclusión. La escala NEWS2-L mostró ser significativamente superior a la escala NEWS2 y similar al ácido láctico en la predicción del deterioro clínico precoz en pacientes con disnea. Esta escala es una ayuda para que la enfermera en su práctica habitual detecte a estos pacientes en forma temprana y así poder orientar los esfuerzos terapéuticos.

Objetivo. Avaliar a capacidade da escala NEWS2-L (National Early Warning Score 2-lactato) de predizer o risco de deterioração clínica precoce (mortalidade de até 48h) em pacientes com dispneia tratados em Serviços de Emergência Médica, em comparação com a escala NEWS2 e a ácido láctico em solitário. Métodos. Estudo prospectivo de coorte multicêntrico de 638 pacientes com dispneia atendidos por ambulância e transferidos com alta prioridade para um serviço de emergência hospitalar nas cidades de Valladolid, Salamanca, Segovia e Burgos (Espanha). As informações foram obtidas a partir de variáveis clínicas, analíticas e demográficas, sendo a principal variável de desfecho a mortalidade por todas as causas em até 48 horas. Para o cálculo do NEWS2, foram seguidas as recomendações do Royal College of Physicians. Uma vez obtidos os valores do NEWS2 e do AL pré-hospitalar, ambos os valores foram somados e o NEWS2-L foi obtido. Resultados. A mortalidade antes de 48 horas foi de 56 pacientes (8,8%). A escala NEWS2-L obteve uma área sob a curva - característica operacional do receptor (ABC-COR) para mortalidade antes de 48 horas de 0.854 (IC 95% 0.790-0.917), em sete dias de 0.788 (IC 95% 0.729-0.848) e aos 30 dias de 0.744 (95% CI 0.692-0.796); em todos os casos p <0,001), experimentando uma diminuição significativa entre o seu valor às 48 he aos 30 dias. Conclusão. A escala NEWS2-L mostrou ser significativamente superior à escala NEWS2 e semelhante ao ácido láctico na predição da deterioração clínica precoce em pacientes com dispneia. Essa escala é um auxílio para o enfermeiro em sua prática habitual detectar precocemente esses pacientes e, assim, ser capaz de orientar os esforços terapêuticos.

Design and development of an early warning score for COVID-19 hospitalized patients / Diseño y desarrollo de un sistema de alerta temprana para pacientes hospitalizados por COVID-19

Abstract Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. Early and accurate identifica tion of high-risk patients in the course of the current COVID-19 pandemic is vital for planning and making proper use of available resources. The purpose of this study was to identify the key variables that account for worse outcomes to create a predictive model that could be used effectively for triage. Through literature review, 44 variables that could be linked to an unfavorable course of COVID-19 disease were obtained, including clinical, laboratory, and X-ray variables. These were used for a 2-round modified Delphi processing with 14 experts to select a final list of variables with the greatest predictive power for the construction of a scoring system, leading to the creation of a new scoring system: the COVID-19 Severity Index. The analysis of the area under the curve for the COVID-19 Severity Index was 0.94 to predict the need for ICU admission in the following 24 hours against 0.80 for NEWS-2. Additionally, the digital medical record of the Hospital Italiano de Buenos Aires was electronically set for an automatic calculation and constant update of the COVID-19 Severity Index. Specifically designed for the current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization, and administration of resources by easily identifying hospitalized patients with a greater need of intensive care.

Resumen La pandemia por COVID-19 planteó un desafío para el sistema salud, debido a la gran demanda de pacientes hospitalizados. La identificación temprana de pacientes hospitalizados con riesgo de evo lución desfavorable es vital para asistir en forma oportuna y planificar la demanda de recursos. El propósito de este estudio fue identificar las variables predictivas de mala evolución en pacientes hospitalizados por COVID-19 y crear un modelo predictivo que pueda usarse como herramienta de triage. A través de una revisión narrativa, se obtuvieron 44 variables vinculadas a una evolución desfavorable de la enfermedad COVID-19, incluyendo variables clínicas, de laboratorio y radiográficas. Luego se utilizó un procesamiento por método Delphi modificado de 2 rondas para seleccionar una lista final de variables incluidas en el score llamado COVID-19 Severity Index. Luego se calculó el Área Bajo la Curva (AUC) del score para predecir el pase a terapia intensiva en las próximas 24 horas. El score presentó un AUC de 0,94 frente a 0,80 para NEWS-2. Finalmente se agregó el COVID-19 Severity Index a la historia clínica electrónica de un hospital universitario de alta complejidad. Se programó para que el mismo se actualice de manera automática, facilitando la planificación estratégica, organización y administración de recursos a través de la identificación temprana de pacientes hospitalizados con mayor riesgo de transferencia a la Unidad de Cuidados Intensivos.

Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance / Structure and roles of rapid response teams for adult care in high complexity hospitals: Scoping review

Resumen Introducción y objetivo: Una importante proporción de pacientes hospitalizados presenta deterioro clínico severo que puede terminar en eventos adversos, paro cardíaco no esperado, o muerte; para reducir su frecuencia y prevenir sus consecuencias se han creado los equipos de respuesta rápida (ERR). El objetivo de esta revisión de alcance es describir la conformación, funcionamiento y resultados de la implementación de los ERR en el contexto hospitalario, con énfasis en los servicios de cirugía ginecológica y atención obstetricia. Materiales y métodos: Se llevó a cabo una búsqueda en las bases de datos de literatura médica Medline vía Pubmed, Embase vía OVID, LILACS, Cochrane Library y Open Gray. Se incluyeron estudios observacionales descriptivos y analíticos, estudios experimentales y estudios cualitativos que incluyeron ERR en instituciones de salud de alta complejidad u hospitales universitarios. Dos investigadores seleccionaron los estudios y extrajeron los datos respecto a la conformación, funcionamiento, los criterios de activación del equipo, los tiempos de respuesta o las herramientas de evaluación de su desempeño. No se hicieron restricciones de fecha o estado de publicación. Se incluyeron estudios en inglés, español y portugués. Se hace síntesis narrativa de los hallazgos. Resultados: La búsqueda arrojó 15,833 títulos, un total de 15 estudios cumplieron con los criterios de inclusión. Solo un estudio menciona el uso de los ERR en servicios de obstetricia. La conformación de los ERR es multidisciplinaria y están disponibles al menos 12 horas cada día. Sus funciones son la identificación temprana de pacientes con deterioro de la condición, especialmente en áreas por fuera de la unidad de cuidados intensivos y de pacientes con condiciones subyacentes o eventos desencadenantes que aumentan el riesgo de paro cardíaco. Además, implementan intervenciones rápidas multifacéticas que incluyen tratamientos farmacológicos, procedimientos cardiopulmonares, y desarrollan actividades de comunicación y formación. Se dispone de herramientas para la activación y evaluación de los procesos asistenciales. Conclusión: La estructura y las funciones del ERR están claramente descritas, lo que permite que sean ensamblados en hospitales de alta complejidad. Se deben realizar más investigaciones sobre los beneficios y riesgos del uso de los ERR para mitigar los daños en pacientes con EREND y comparar la efectividad y seguridad entre la activación de códigos y las estrategias de ERR en los servicios de obstetricia.

Abstract Introduction and Objective: A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods: A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results: Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion: The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.

Practice and nursing care of early activity program for patients after cardiac valve replacement / 中国实用护理杂志

Objective:To summarize the practical and nursing experience of early activity program for patients after cardiac valve replacement.Methods:Totally 156 patients after cardiac valve replacement from December 2018 to June 2019 were selected. Refer to the seven-steps of cardiac rehabilitation recommended by American Heart Association with daily activity training and Guidelines for cardiovascular rehabilitation and secondary prevention in China, an early activity program based on corrected modified early warning score (MEWS) was offered to the patients, than its effect was evaluated.Results:All the 156 patients were successfully extubated, no adverse events such as pressure ulcers, pipe slip-off and wound dehiscence occurred.Conclusion:On the basis of the correct evaluation of the patient's condition after heart valve replacement, early activities can promote the recovery of cardiopulmonary function and accelerate the recovery of the patient.

Utilidad de una escala de alerta temprana como predictor precoz de deterioro clínico en niños internados / Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children

Introducción. La detección temprana del deterioro clínico en pacientes internados posibilita mejorar la calidad de atención médica. Las escalas Pediatric Early Warning Score (PEWS) predicen este deterioro dentro de las primeras 24 h de aplicadas. Estudios previos avalan estas herramientas.Objetivo. Evaluar la utilidad de la escala B-PEWS(Brighton PEWS) para predecir el deterioro clínico en niños internados, en un hospital pediátrico de la Ciudad de Buenos Aires.Población y métodos. Diseño de corte transversal. Incluyó todas las historias clínicas de pacientes de 1 mes a 18 años hospitalizados en áreas de hospitalización indiferenciada, desde el 1 de marzo al 31 de agosto de 2018. Variable de predicción: valor de B-PEWS (≤ 3 y ≥ 4 puntos). Variable de resultado: deterioro clínico dentro de las 24 horas. Análisis de variables categóricas mediante prueba de chi2 y cálculo de valores de clivaje. Como medida de asociación, se usó riesgo relativo. Se realizó análisis de curva ROCy análisis de punto óptimo mediante índice de Youden, tomando la escala de manera continua.Resultados. Se analizaron 518 historias clínicas. Cuarenta pacientes presentaron deterioro clínico; 37 con B-PEWS ≥ 4, y 3 con B-PEWS ≤ 3 (RR 56,36; IC 95 %: 17,76-178,89; p < 0,01). Sensibilidad: el 92,5 %; especificidad: el 88,3 %; valor predictivo positivo: el 39,8 %; negativo: el 99,3 %; razón de verosimilitud positiva: 7,91; razón de verosimilitud negativa: 0,08. AUC: 0,94 (IC 95 %: 0,89-0,98).Conclusión. La escala B-PEWS demostró ser útil para predecir el deterioro clínico en niños hospitalizados

Introduction. The early detection of clinical deterioration in hospitalized patients helps to improve the quality of care. The pediatric early warning score (PEWS) system predicts such deterioration in the first 24 hours of administration. Prior studies support the use of these tools.Objective. To assess the usefulness of the Brighton PEWS (B-PEWS) for the prediction of clinical deterioration among hospitalized children at a children's hospital in the Autonomous City of Buenos Aires.Population and methods. Cross-sectional study. The medical records of all patients aged 1 month to 18 years admitted to any hospitalization ward between March 1st and August 31st, 2018 were included. Predictive outcome measure: B-PEWS score (≤ 3 and ≥ 4 points). Outcome variable: clinical deterioration in the first 24 hours. Categorical outcome measures were analyzed with the χ² test and screening values were estimated. The relative risk was used as a measure of association. A ROC curve analysis and an optimal cut-point analysis according to the Youden index were done considering the score in a continuous manner.Results. A total of 518 medical records were reviewed. Forty patients had clinical deterioration; the B-PEWS score was ≥ 4 in 37 patients and ≤ 3 in 3 (relative risk: 56.36; 95 % confidence interval: 17.76-178.89; p < 0.01). Sensitivity: 92.5 %; specificity: 88.3 %; positive predictive value: 39.8 %; negative predictive value: 99.3 %; positive likelihood ratio: 7.91; negative likelihood ratio: 0.08. AUC:0.94 (95 % confidence interval: 0.89-0.98).Conclusion. The B-PEWS demonstrated to be useful to predict clinical deterioration in hospitalized children.

Analysis of the effect of improved early warning score on the theory and practice interactive infiltration training model for surgical internship nurses / 中国实用护理杂志

Objective@#To study the application value of improved early warning score in the practice of theory and practice interactive infiltration training mode for neurosurgery interns.@*Methods@#A total of 84 neurosurgery interns were selected as study samples and randomly divided into control group and intervention group by random double blind method, each group had 42 interns. The control group adopted the interactive infiltration model of theory and practice. The Intervention group adopted the interactive infiltration training mode of theory and practice under the improved early warning scoring system design. Statistics and comparison of the performance of the two groups of trainee nurses, the evaluation of teaching teachers and patients, the self-evaluation of trainee nurses, and the occurrence of nursing errors during the internship.@*Results@#The related examination results between the two groups showed significance (t value was 7.182,5.462,5.530, P<0.01). The evaluation for nursing students by teachers and patients also showed significant difference (t value was 6.989-8.790, P<0.01). The incidence of error event in the intervention group was 9.52% (4/42), lower than that in the control group [30.95% (13/42)]. There was statistical difference between two groups (χ2 value was 14.227, P<0.01).@*Conclusions@#The application of the improved early warning score in the theory and practice interactive infiltration training mode of neurosurgery interns can improve the satisfaction of teachers and patients to interns, enhance the self-satisfaction of interns and reduce the incidence of nursing errors of interns.

Application of modified early warning score automatic disease early warning system combined with situation, background, assessment and recommen-dation in early warning of disease / 中国实用护理杂志

Objective@#To develop an automatic warning software system for MEWS, and apply the MEWS system and SBAR communication mode to the early warning of surgical patients to evaluate its implementation effect.@*Methods@#From November 2017 to November 2018, 400 patients in the People′s Hospital of Guigang City, Guangxi, with vital signs and critical illness after surgery were divided into 200 patients in the control group and 200 in the study group according to the random number table. The control group: routinely calculated MEWS scores and reported abnormal values to the doctor to treat the patient′s condition. The research group: Combining MEWS assignment with computer technology, developing MEWS automatic disease warning software system and combining it with SBAR communication mode for early warning of surgical patients′ condition, comparing the two groups′ disease evaluation time, treatment response speed, communication completion rate and Whether patients and doctors have different job satisfaction with nurses.@*Results@#The disease assessment time and treatment response rate of the study group were (45.89±1.528) seconds and (1.22±0.57) minutes, respectively. The control group was (58.01±5.123) seconds and (3.19±1.56) minutes respectively. The difference between the two groups was significant (t=32.078, -7.899, P<0.01). The communication completion rate of the study group, the patient's job satisfaction to the nurses, and the doctor's job satisfaction to the nurses was 96.0% (192/200), 91.5% (183/200) and 97.0% (194/200) respectively. The rate in the control group was 61.5% (123/200), 79.0% (158/200), and 78.0% (156/200) respectively, the difference between the two groups was significant (χ2=71.126, 12.426, 33.006, P < 0.01).@*Conclusion@#The MEWS automatic warning software system and SBAR communication mode can be used to quickly assess the patient′s condition, improve the accuracy of medical communication, alert patients to potential risks and severity of illness, and improve nurses' work efficiency and patient and doctor's satisfaction with nurses' work degree.

Construction of a graded response system based on pediatric early warning score / 中国实用护理杂志

Objective@#A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses.@*Methods@#Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system.@*Results@#The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points.@*Conclusions@#The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′ participation in clinical intervention decision-making and improve the quality of nursing.

Effect of pediatric early warning score on assessing the condition of children from emergency department admission to pediatric intensive care unit / 中华实用儿科临床杂志

Objective@#To investigate the effect of pediatric early warning score(PEWS) on the evaluation of severity of emergency children admitted to pediatric intensive care unit(PICU).@*Methods@#A total of 1 069 cases hospitalized through emergency room into PICU in Guiyang Children′s Hospital, from January to December in 2017 were analyzed, and the PEWS was recorded for the first time in emergency room and PICU, while receiver operating curve was used to analyze the efficacy of PEWS to diagnose the children, who were at risk of clinical deterioration and required transfer to the PICU, which included the sensitivity, specificity, Youden index.The diagnostic value of PEWS in asse-ssing the severity of disease in critically ill children was explored.@*Results@#The 1 069 severe cases of PICU ranged from 1 month to 13 years and 8 months, and PEWS score was (4.6±0.8) scores in the emergency room, and (5.1±0.5) scores in the PICU, so there were significant differences of the PEWS score between the death group [(8.0±0.5) scores] and the survival group [(4.8±0.8) scores] in the emergency room and PICU(all P<0.05). The PEWS score of the respiratory, nervous, circulatory and digestive system groups in PICU was (5.8±0.5) scores, while other systemic diseases (blood, kidney, poisoning, and so on) PEWS score was(4.2±0.5) scores; which showed significant differences between 2 groups(t=4.60, P<0.05). In PICU, the score of PEWS was greater than or equal to 4.7, which was the demarcation point to distinguish the critical condition and predict the death risk of the patient.@*Conclusions@#PEWS is of great significance for assessing the children sent to PICU.Patients with mainly respiratory, circulatory, neurological, and digestive system diseases have higher PEWS scores.The PEWS score of other system diseases is significantly reduced.It is suggested that PEWS is not able to reflect the disease of such a system and needs to be taken seriously.