An in-hospital optimized early warning score demonstrated an area under the curve of 0.814 (95% CI 0.79-0.83) for predicting patient deterioration, compared to 0.740 for the National Early Warning Score.
Observational
No
Does an in-hospital optimized early warning score improve prediction of patient deterioration compared to the National Early Warning Score in patients on medical wards?
An in-hospital optimized early warning score demonstrated superior predictive performance for patient deterioration compared to the off-the-shelf National Early Warning Score.
Absolute Event Rate: 0.814% vs 0.74%
Background. Identification of patients at risk of deteriorating during their hospitalization is an important concern. However, many off-shelf scores have poor in-center performance. In this article, we report our experience developing, implementing, and evaluating an in-hospital score for deterioration. Methods. We abstracted 3 years of data (2014–2016) and identified patients on medical wards that died or were transferred to the intensive care unit. We developed a time-varying risk model and then implemented the model over a 10-week period to assess prospective predictive performance. We compared performance to our currently used tool, National Early Warning Score. In order to aid clinical decision making, we transformed the quantitative score into a three-level clinical decision support tool. Results. The developed risk score had an average area under the curve of 0.814 (95% confidence interval = 0.79–0.83) versus 0.740 (95% confidence interval = 0.72–0.76) for the National Early Warning Score. We found the proposed score was able to respond to acute clinical changes in patients’ clinical status. Upon implementing the score, we were able to achieve the desired positive predictive value but needed to retune the thresholds to get the desired sensitivity. Discussion. This work illustrates the potential for academic medical centers to build, refine, and implement risk models that are targeted to their patient population and work flow.
O’Brien et al. (Wed,) conducted a observational in Patient deterioration on medical wards. In-hospital optimized early warning score vs. National Early Warning Score was evaluated on Predictive performance (area under the curve) for death or ICU transfer (95% CI 0.79-0.83). An in-hospital optimized early warning score demonstrated an area under the curve of 0.814 (95% CI 0.79-0.83) for predicting patient deterioration, compared to 0.740 for the National Early Warning Score.