Stenhouse et al reported a modified early warning score (EWS) for identifying a critically ill patient on a general surgical ward. This can help to identify a patient who may require aggressive management. The authors are from Queen Hospital and Burton Hospitals in Burton on Trent in England.
This EWS is a modification of the one reported by Morgan et al.
Parameters:
(1) heart rate in beats per minute
(2) respiratory rate in breaths per minute
(3) body temperature in °C
(4) CNS status (AVPU)
(5) urine output in mL per kg per hour
(6) systolic blood pressure in mm Hg
Parameter |
Finding |
Points |
heart rate |
< 40 |
2 |
|
40 to 50 |
1 |
|
51 to 100 |
0 |
|
101 to 110 |
1 |
|
111 to 129 |
2 |
|
>= 130 |
3 |
respiratory rate |
<= 8 |
3 |
|
9 to 14 |
0 |
|
15 to 20 |
1 |
|
21 to 29 |
2 |
|
>= 30 |
3 |
temperature |
< 35.0°C |
2 |
|
35.0 to 38.4°C |
0 |
|
>= 38.5°C |
2 |
CNS status |
alert |
0 |
|
responds to voice |
1 |
|
responds to pain |
2 |
|
unresponsive to all stimuli |
3 |
urine output |
none |
3 |
|
< 1 mL per kg in 2 hours |
2 |
|
< 1 mL per kg in 1 hour |
1 |
|
> 3 mL per kg in 2 hours |
1 |
systolic blood pressure |
normal for patient |
0 |
|
more than 45% lower than normal |
3 |
|
30% lower than normal |
2 |
|
15% lower than normal |
1 |
|
15% above normal |
1 |
|
30% above normal |
2 |
|
> 45% above normal |
3 |
where:
• The urine output could be ambiguous in certain circumstances. It might be clearer if "< 1 mL per kg in 1 hour" was "< 2 mL per kg in 2 hours". It is then needed to add an additional item for 2-3 mL in 2 hours, probably worth 0 points.
• There are gaps in the systolic blood pressure ranges.
modified EWS score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more serious the patient's condition.
• A score >= 4 resulted in a review by the ward staff which could be followed by a response by the intensive care unit response team.
Purpose: To identify a patient on a general surgical ward who should be evaluated based on the modified Early Warning Score of Stenhouse et al.
Objective: differential diagnosis and mimics, red flags
ICD-10: ,