Why the study?
NHS England mandated the National Early Warning Score of vital signs across UK acute hospital trusts despite limited validation in the postoperative setting.
Does a logistic early warning score improve the prediction of death, cardiac arrest, or unplanned intensive care unit re-admission compared to the National Early Warning Score in adults after cardiac surgery?
Does a logistic early warning score improve the prediction of death, cardiac arrest, or unplanned intensive care unit re-admission compared to the National Early Warning Score in adults after cardiac surgery?
A logistic early warning score significantly improves the prediction of death, cardiac arrest, or unplanned ICU readmission in postoperative cardiac surgery patients compared to the standard additive National Early Warning Score.
Logistic EWS may improve event prediction after cardiac surgery; leaves open prospective validation before routine adoption.
Summary NHS England recently mandated that the National Early Warning Score of vital signs be used in all acute hospital trusts in the UK despite limited validation in the postoperative setting. We undertook a multicentre UK study of 13,631 patients discharged from intensive care after risk‐stratified cardiac surgery in four centres, all of which used Vital PAC TM to electronically collect postoperative National Early Warning Score vital signs. We analysed 540,127 sets of vital signs to generate a logistic score, the discrimination of which we compared with the national additive score for the composite outcome of: in‐hospital death; cardiac arrest; or unplanned intensive care admission. There were 578 patients (4.2%) with an outcome that followed 4300 sets of observations (0.8%) in the preceding 24 h: 499 out of 578 (86%) patients had unplanned re‐admissions to intensive care. Discrimination by the logistic score was significantly better than the additive score. Respective areas (95% CI ) under the receiver‐operating characteristic curve with 24‐h and 6‐h vital signs were: 0.779 (0.771–0.786) vs. 0.754 (0.746–0.761), p < 0.001; and 0.841 (0.829–0.853) vs. 0.813 (0.800–0.825), p < 0.001, respectively. Our proposed logistic Early Warning Score was better than the current National Early Warning Score at discriminating patients who had an event after cardiac surgery from those who did not.
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Chiu et al. (2019) studied this question.
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