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    Early Warning Scores in The ED

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    Ahmad Syamsul ThelionArema
    This document discusses the evolution of early warning scores (EWS) used in emergency departments. It outlines several EWS systems developed over time, including the Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS). The document also notes that EWS are now recommended for monitoring all hospital patients in the UK and that the Department of Health includes EWS assessment for ambulance patients attending the emergency department. It concludes by questioning the future of EWS and their role in emergency care.

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    Early Warning Scores in The ED

    Uploaded by

    Ahmad Syamsul ThelionArema
    17 views15 pages
    This document discusses the evolution of early warning scores (EWS) used in emergency departments. It outlines several EWS systems developed over time, including the Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS). The document also notes that EWS are now recommended for monitoring all hospital patients in the UK and that the Department of Health includes EWS assessment for ambulance patients attending the emergency department. It concludes by questioning the future of EWS and their role in emergency care.

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    This document discusses the evolution of early warning scores (EWS) used in emergency departments. It outlines several EWS systems developed over time, including the Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS). The document also notes that EWS are now recommended for monitoring all hospital patients in the UK and that the Department of Health includes EWS assessment for ambulance patients attending the emergency department. It concludes by questioning the future of EWS and their role in emergency care.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    17 views15 pages

    Early Warning Scores in The ED

    Uploaded by

    Ahmad Syamsul ThelionArema
    This document discusses the evolution of early warning scores (EWS) used in emergency departments. It outlines several EWS systems developed over time, including the Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS). The document also notes that EWS are now recommended for monitoring all hospital patients in the UK and that the Department of Health includes EWS assessment for ambulance patients attending the emergency department. It concludes by questioning the future of EWS and their role in emergency care.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    Early Warning Scores in the ED

    Objectives
     Evolution of Early Warning Scores
     Rapid Emergency Medicine Score (REMS)
     National Early Warning Score (NEWS)
     EWS in the ED
     Future work?
     Conclusion
    Background
    First EWS
    Developed in 1997 by
    Morgan et al
    Based on five
    physiological
    parameters:
    SBP
    Pulse
    Resp rate
    Temp
    AVPU

    Morgan et al. Clin Intensive Care 1997;8:100


    M(odified)EWS
    Surgical patients
    Deviation from normal
    BP
    Urine output
    Potential benefit from
    critical care

    Stenhouse et al. Br J Anaesth 2000;84:663


    Patients at risk
    Score 3 2 1 0 1 2 3
    SBP <70 71-80 81-100 101-199 ≥200

    HR <40 41-50 51-100 101-110 111-129 ≥130

    RR <9 9-14 15-20 21-29 ≥30

    Temp <35 35-38.4 ≥38.5

    AVPU Alert Voice Pain Un-


    respon
    sive

    Subbe et al. Q J Med 2001;94:521-526


    REMS
    0 1 2 3 4 5 6

    Age <45 45-54 55-64 65-74 >74

    HR 70-109 55-69 40-54 <40


    110-139 140-179 >179
    RR 12-24 10-11 6-9 35-49 >49
    25-34
    SBP 90-129 70-89 150-179 <69
    130-149 >179
    GCS >13 11-13 8-10 5-7 <5

    O2 >89 86-89 75-85 <75

    Olsson & Lind. Acad Emerg Med 2003;10:1040-1048


    NICE
    The National Institute for Health and Clinical
    Excellence (NICE) have recommended that
    physiological track and trigger systems should be used
    to monitor all adult patients in acute hospital settings

    NICE Clinical Guideline 50 (2007)


    DoH Clinical Indicators
    The new Department of Health Quality Indicators
    that will replace the four-hour standard record a time
    to full initial assessment of patients attending EDs
    which includes a pain score and early warning score
    in patients arriving by 999 ambulance

    Department of Health 2011


    NEWS
    Royal College of
    Physicians working party
    July 2012
    Based on a large number
    of vital signs from an
    electronic patient
    database
    The Future?
    Finally...

    Smith et al. Resuscitation 2013. 84:465-470

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