James Griffiths Consultant EM Barnsley CEM FOAMed Network @YorksHumberFoam.
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Transcript of James Griffiths Consultant EM Barnsley CEM FOAMed Network @YorksHumberFoam.
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James GriffithsConsultant EM
BarnsleyCEM FOAMed Network
@YorksHumberFoam
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Objectives Evolution of Early Warning Scores Rapid Emergency Medicine Score (REMS) National Early Warning Score (NEWS) EWS in the ED Future work? Conclusion
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First EWSDeveloped in 1997
by Morgan et alBased on five
physiological parameters:SBPPulseResp rateTempAVPU
Morgan et al. Clin Intensive Care 1997;8:100
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M(odified)EWSSurgical patients
Deviation from normal BP
Urine outputPotential benefit
from critical care
Stenhouse et al. Br J Anaesth 2000;84:663
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Patients at riskScore
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-responsive
Subbe et al. Q J Med 2001;94:521-526
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REMS0 1 2 3 4 5 6
Age <45 45-54 55-64 65-74 >74
HR 70-109 55-69110-139
40-54140-179
<40>179
RR 12-24 10-1125-34
6-9 35-49 >49
SBP 90-129 70-89130-149
150-179
<69>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
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NICEThe 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)
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DoH Clinical IndicatorsThe 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
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NEWSRoyal College of
Physicians working party July 2012
Based on a large number of vital signs from an electronic patient database
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Prytherch et al. Resuscitation 2010. 81:932-937
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Smith et al. Resuscitation 2013. 84:465-470
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The Future?
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Smith et al. Resuscitation 2013. 84:465-470