EWS

Sensitivity of the Adult Early Warning System (EWS) in Ruling Out Cardiac Arrests in the Wards …

Lee, P.J.1, Hartigan, S1,2., Dow, A.1,2, Banas, C.1,2, Sessler, C.N.1,2,3,4, Kashiouris M.G.1,2,3,4 1Virginia

Commonwealth University 2Department of Medicine, Division of Pulmonary & Critical Care Medicine, Virginia Commonwealth University 3Division of Pulmonary & Critical Care Medicine, Virginia Commonwealth University 4Center for Adult Critical Care, Virginia Commonwealth University

Background & Hypothesis •

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In-hospital cardiopulmonary (IHCA) arrests lead to high rates of mortality, with approximately 25% of patients succumbing to initial insult.

Studies suggest physiological changes may precede a cardiac event, which indicate a possibility of identifying high-risk patient for early intervention to prevent mortality. Aim of the current study is to validate the EWS as a tracking tool for identifying patients in hospital wards or ICU setting at risk of cardiac arrest, and to optimize the sensitivity of EWS using retrospective analysis of patient data.

Results •

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Table 1

166 patient suffered cardiopulmonary arrests during the study period. After applying the exclusion criteria, a total of 102 patients’ EWS score were analyzed. (Figure 1) For ward patients prior to the arrest there was a slight increase in the average EWS scores from 1.18 to 1.28 and 1.62 at 1 st, 2nd and 3rd intervals, respectively.

EWS

All calculated data on sensitivity (Sn) is shown on Table 1 A (Ward) and B (ICU)

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LACE score with a threshold of >10 demonstrated a sensitivity of 75% for ward patients; 57.8% for ICU patients.

≥4

≥5

≥6

N

Sn(%)

N

Sn(%)

N

Sn(%)

N

Sn(%)

1st interval (34)

8

23.5

4

11.8

3

8.8

1

2.9

2nd interval (36)

5

13.9

4

11.1

4

11.1

1

2.8

3rd interval (38)

8

21.1

2

5.3

0

0

0

0

A. Max EWS at 1st, 2nd, and 3rd 4-hour intervals preceding IHCA in Ward Patients

ICU patients prior to the arrest showed a similar increase in the average EWS score from 3.95 to 4.35 and 5.16 at 1 st, 2nd and 3rd intervals, respectively.

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≥3

EWS

≥3

≥4

≥5

≥6

≥7

≥8

N

Sn(%)

N

Sn(%)

N

Sn(%)

N

Sn(%)

N

Sn(%)

N

Sn(%)

1st interval (62)

52

83.9

46

74.2

36

58.1

26

41.9

16

25.8

8

12.9

2nd interval (63)

43

68.3

36

57.1

25

39.7

20

31.7

13

20.6

8

12.7

3rd interval (62)

36

58.1

30

48.4

24

38.7

17

27.4

9

14.5

8

12.9

B. Max EWS at 1st, 2nd, and 3rd 4-hour intervals preceding IHCA in ICU Patients

Methods • •

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Total IHCA patient from Jan 2016 to Oct 2016 N=166

Retrospective observational study (January 2016 – October 2016) VCU Medical Center: 725-bed academic tertiary care hospital in Richmond, Virginia

Patients aged 18 years or older, who suffered cardiopulmonary arrest in either the wards or the ICU setting.

Data were extracted from EMR and billing databases and analyzed with STATA® (StataCorp. 2015, Stata Statistical Software. Release 14.2 College Station, Texas. StataCorp LP)

Patients excluded: Pediatric, N=16 Trauma, N=9 Prior PEA, N=5 Multiple IHCA, N=9 IHCA within 12 hr, N=13 Insufficient data, N=12

Total adult EWS analyzed

Max EWS and its components (Figure 2) were collected for three 4-hour intervals (1st interval 0-4 hours; 2nd interval 4-8 hours; 3rd interval 8-12 hours prior to cardiac event). LACE score was also collected.

Conclusions

Figure 2

Figure 1

N=102

Ward Patients

ICU patients

N=39

N=63

EWS points

3

2

1

0

1

2

3

RASS

-

+4 to +2

-

+1 to -1

-2 to -3

-4

-5

Resp rate

30

Heart rate

130

SBP

220

Temp

40

spO2