Evidence-Based Medicine
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2018; 7(3): 39-45
Published online Aug 4, 2018. doi: 10.5492/wjccm.v7.i3.39
Validation of the VitalPAC Early Warning Score at the Intermediate Care Unit
Joost DJ Plate, Linda M Peelen, Luke PH Leenen, Falco Hietbrink
Joost DJ Plate, Luke PH Leenen, Falco Hietbrink, Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
Linda M Peelen, Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
Linda M Peelen, Departments of Anaesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: There are no conflicts of interest arising from this work.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joost DJ Plate, MD, MSc, Research Scientist, Division of Surgery, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands. j.d.j.plate@umcutrecht.nl
Telephone: +31-88-7555555 Fax: +31-88-7555438
Received: March 20, 2018
Peer-review started: March 20, 2018
First decision: April 23, 2018
Revised: June 19, 2018
Accepted: June 26, 2018
Article in press: June 27, 2018
Published online: August 4, 2018
Processing time: 139 Days and 12.7 Hours
Abstract
AIM

To assess the performance and clinical relevance of the Early Warning Scoring (EWS) system at the Intermediate Care Unit (IMCU).

METHODS

This cohort study used all the VitalPAC EWS (ViEWS) scores collected during each nursing shift from 2014 through 2016 at the mixed surgical IMCU of an academic teaching hospital. Clinical deterioration defined as transfer to the Intensive Care Unit (ICU) or mortality within 24 h was the primary outcome of interest.

RESULTS

A total of 9113 aggregated ViEWS scores were obtained from 2113 admissions. The incidence of the combined outcome was 272 (3.0%). The area under the curve of the ViEWS was 0.72 (CI: 0.69-0.75). Using a threshold value of six, the sensitivity was 68% with a positive predictive value of 5% and a number needed to trigger (e.g., false alarms) of 19%.

CONCLUSION

The ViEWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward. The number of false alarms is high, which may result in alarm fatigue. Therefore, use of the ViEWS in its current form at the IMCU should be reconsidered.

Keywords: Intermediate Care Unit; High-dependency unit; Clinical deterioration; Vital signs; Early Warning Scoring

Core tip: This study used all the routinely collected Early Warning Scores (EWS) in every nursing shift from 2014 to 2016 (n = 9113) at the standalone Intermediate Care Unit to assess the performance and clinical relevance of the EWS to detect clinical deterioration amongst patients admitted in this critical care facility. It follows that although the discriminative performance was acceptable (AUC 0.72), the clinical relevance is limited as 19 false alarms were needed to detect one event. As this may result in alarm fatigue, its use in this setting should be reconsidered.