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      Risk stratification of hospitalized patients on the wards.

      1 , ,
      Chest

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          Abstract

          Patients who suffer adverse events on the wards, such as cardiac arrest and death, often have vital sign abnormalities hours before the event. Early warning scores have been developed with the aim of identifying clinical deterioration early and have been recommended by the National Institute for Health and Clinical Excellence. In this review, we discuss recently developed and validated risk scores for use on the general inpatient wards. In addition, we compare newly developed systems with more established risk scores such as the Modified Early Warning Score and the criteria used in the Medical Early Response Intervention and Therapy (MERIT) trial in our database of > 59,000 ward admissions. In general we found the single-parameter systems, such as the MERIT criteria, to have the lowest predictive accuracy for adverse events, whereas the aggregate weighted scoring systems had the highest. The Cardiac Arrest Risk Triage (CART) score was best for predicting cardiac arrest, ICU transfer, and a composite outcome (area under the receiver operating characteristic curve [AUC], 0.83, 0.77, and 0.78, respectively), whereas the Standardized Early Warning Score, VitalPAC Early Warning Score, and CART score were similar for predicting mortality (AUC, 0.88). Selection of a risk score for a hospital or health-care system should be guided by available variables, calculation method, and system resources. Once implemented, ensuring high levels of adherence and tying them to specific levels of interventions, such as activation of a rapid response team, are necessary to allow for the greatest potential to improve patient outcomes.

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          Author and article information

          Journal
          Chest
          Chest
          1931-3543
          0012-3692
          Jun 2013
          : 143
          : 6
          Affiliations
          [1 ] Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, USA.
          Article
          S0012-3692(13)60409-2
          10.1378/chest.12-1605
          3673668
          23732586
          f556e0f2-ad5b-40d5-a328-c912c79b7517
          History

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