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Worthing Physiological Scoring System (PSS) of Duckitt et al as a Medical Inpatient Early Warning System

Purpose: To identify a medical inpatient who is at increased risk for mortality using the Worthing physiologic scoring system (PSS) of Duckitt et al.

Description

Duckitt et al developed a physiological scoring system (PSS) that can serve as an early warning system for medical patients admitted to the hospital. The authors are from Worthing Hospital and University of Brighton in England.


Parameters:

(1) ventilatory (respiratory) rate

(2) pulse

(3) systolic blood pressure

(4) temperature

(5) oxygen saturation on room air

(6) AVPU (alert, verbal response, pain response, unresponsive)

 

Parameter

Finding

Points

ventilatory rate

<= 19 breaths per minute

0

 

20 to 21

1

 

>= 22

2

pulse

<= 101 beats per minute

0

 

>= 102 beats per minute

1

systolic blood pressure

>= 100 mm Hg

0

 

<= 99 mm Hg

2

temperature

>= 35.3°C

0

 

< 35.3°C

3

oxygen saturation on room air

>= 96%

0

 

94 to 95.9%

1

 

92 to 93.9%

2

 

< 92%

3

level of consciousness

alert (A)

0

 

VPU

3

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 14

• The optimum cutoff was >= 3.

• The mortality rate was 10% for a score of 3, 20% for a score of 6 and 50% for >= 8.

• A patient with a score of 2, 3 or 4 should be observed more frequently. The patient's physician should be consulted if the score is rising or for a score >= 5.

 

Performance:

• Using a cutoff of >= 3, the sensitivity was 0.63 and specificity 0.72.

• The area under the ROC curve was 0.74.


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Objective

ICD-10