Widely used track and trigger scores

Are they ready for automation in practice?

Santiago Romero-Brufau, Jeanne M. Huddleston, James M Naessens, Matthew G. Johnson, Joel Hickman, Bruce W. Morlan, Jeffrey B. Jensen, Sean M. Caples, Jennifer L. Elmer, Julie A. Schmidt, Timothy Ian Morgenthaler, Paula J. Santrach

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.

Original languageEnglish (US)
Pages (from-to)549-552
Number of pages4
JournalResuscitation
Volume85
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Automation
Vital Signs
Resuscitation
Observation
Databases
Sensitivity and Specificity

Keywords

  • Automation
  • Cardiorespiratory arrests
  • Early warning score
  • Patient safety
  • Rapid response system
  • Track-and-trigger

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine
  • Medicine(all)

Cite this

Romero-Brufau, S., Huddleston, J. M., Naessens, J. M., Johnson, M. G., Hickman, J., Morlan, B. W., ... Santrach, P. J. (2014). Widely used track and trigger scores: Are they ready for automation in practice? Resuscitation, 85(4), 549-552. https://doi.org/10.1016/j.resuscitation.2013.12.017

Widely used track and trigger scores : Are they ready for automation in practice? / Romero-Brufau, Santiago; Huddleston, Jeanne M.; Naessens, James M; Johnson, Matthew G.; Hickman, Joel; Morlan, Bruce W.; Jensen, Jeffrey B.; Caples, Sean M.; Elmer, Jennifer L.; Schmidt, Julie A.; Morgenthaler, Timothy Ian; Santrach, Paula J.

In: Resuscitation, Vol. 85, No. 4, 2014, p. 549-552.

Research output: Contribution to journalArticle

Romero-Brufau, S, Huddleston, JM, Naessens, JM, Johnson, MG, Hickman, J, Morlan, BW, Jensen, JB, Caples, SM, Elmer, JL, Schmidt, JA, Morgenthaler, TI & Santrach, PJ 2014, 'Widely used track and trigger scores: Are they ready for automation in practice?', Resuscitation, vol. 85, no. 4, pp. 549-552. https://doi.org/10.1016/j.resuscitation.2013.12.017
Romero-Brufau, Santiago ; Huddleston, Jeanne M. ; Naessens, James M ; Johnson, Matthew G. ; Hickman, Joel ; Morlan, Bruce W. ; Jensen, Jeffrey B. ; Caples, Sean M. ; Elmer, Jennifer L. ; Schmidt, Julie A. ; Morgenthaler, Timothy Ian ; Santrach, Paula J. / Widely used track and trigger scores : Are they ready for automation in practice?. In: Resuscitation. 2014 ; Vol. 85, No. 4. pp. 549-552.
@article{53f3812ff8874d96b5dd59720464d710,
title = "Widely used track and trigger scores: Are they ready for automation in practice?",
abstract = "Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.",
keywords = "Automation, Cardiorespiratory arrests, Early warning score, Patient safety, Rapid response system, Track-and-trigger",
author = "Santiago Romero-Brufau and Huddleston, {Jeanne M.} and Naessens, {James M} and Johnson, {Matthew G.} and Joel Hickman and Morlan, {Bruce W.} and Jensen, {Jeffrey B.} and Caples, {Sean M.} and Elmer, {Jennifer L.} and Schmidt, {Julie A.} and Morgenthaler, {Timothy Ian} and Santrach, {Paula J.}",
year = "2014",
doi = "10.1016/j.resuscitation.2013.12.017",
language = "English (US)",
volume = "85",
pages = "549--552",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "4",

}

TY - JOUR

T1 - Widely used track and trigger scores

T2 - Are they ready for automation in practice?

AU - Romero-Brufau, Santiago

AU - Huddleston, Jeanne M.

AU - Naessens, James M

AU - Johnson, Matthew G.

AU - Hickman, Joel

AU - Morlan, Bruce W.

AU - Jensen, Jeffrey B.

AU - Caples, Sean M.

AU - Elmer, Jennifer L.

AU - Schmidt, Julie A.

AU - Morgenthaler, Timothy Ian

AU - Santrach, Paula J.

PY - 2014

Y1 - 2014

N2 - Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.

AB - Introduction: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. Methods: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36. h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. Results: PPVs ranged from less than 0.01 (Worthing, 3. h) to 0.21 (GMEWS, 36. h). Sensitivity ranged from 0.07 (GMEWS, 3. h) to 0.75 (ViEWS, 36. h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. Conclusions: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.

KW - Automation

KW - Cardiorespiratory arrests

KW - Early warning score

KW - Patient safety

KW - Rapid response system

KW - Track-and-trigger

UR - http://www.scopus.com/inward/record.url?scp=84895918244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895918244&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2013.12.017

DO - 10.1016/j.resuscitation.2013.12.017

M3 - Article

VL - 85

SP - 549

EP - 552

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 4

ER -