Early warning score system to predict deterioration reduces in-hospital cardiac arrest events
Implementation of an electronic national early warning score (NEWS) information system may cut the rate of in-hospital cardiac arrest (IHCA), as well as improve the rate of survival to discharge, as shown in a study presented at the Asian Pacific Society of Cardiology (APSC) Congress 2018.
Designed to facilitate early detection of physiological deterioration in patients, the computer-based scoring system consists of a simple algorithm based on key vital sign parameters, including respiratory rate, heart rate and systolic blood pressure, among others.
The system triggers a warning signal when scores reach or exceed a certain number, informing of the high possibility of acute deterioration in patient condition so that physicians or hospital staff can initiate appropriate management. At scores of ≥7, a red light is activated. This red light then starts blinking at scores greater than the highest score from the last three measurements.
In the present study, 181,169 consecutive patients admitted to a tertiary medical centre between 2013 and 2016 were grouped into three according to the timing of NEWS implementation in the centre: before intervention (Jan 2013 to April 2015; n=707,957 patient-day), during intervention (May to June 2015; n=52,687 patient-day) and after intervention (July 2015 to November 2016; n=423,241 patient-day).
IHCA rates decreased from 2.53 percent before intervention to 2.15 percent during intervention and to 1.56 percent after intervention (p<0.05). [APSC 2018, abstract P072]
At night, IHCA rates before, during and after intervention dropped from 0.69 percent to 0.46 percent and to 0.36 percent (p<0.05), respectively. Likewise, rates at weekend decreased from 0.54 percent to 0.46 percent and to 0.39 percent (p<0.05), respectively.
Finally, the rate of survival to discharge in IHCA patients with survival to 48 hours increased significantly from 45 percent before intervention to 71 percent during intervention and to 80 percent after intervention (p<0.05).
The present data suggest that introducing a NEWS information system can lead to a reduction in the incidence of IHCAs as a result of the immediate provision of initial treatment to patients, according to researchers.
Patients who experience cardiac arrest or need intensive care unit management generally show signs of deterioration in clinical findings several hours prior to the event. When these signs are missed and appropriate treatment is not given, the odds of survival drop. [Resuscitation 2004;62:275-282; Intensive Care Med 2007;33:237-245]