Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score

Tirkkonen, Joonas; Olkkola, Klaus T.; Huhtala, Heini; Tenhunen, Jyrki; Hoppu, Sanna

doi:10.1111/aas.12277

Cited by 42 publications

(49 citation statements)

References 38 publications

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“…Our results complement those of Tirkkonen et al who showed that high NEWS values were associated with serious adverse events in hospital, but MET criteria were not (13). NEWS was also independently associated with higher mortality, whereas MET criteria were not.…”

Section: Discussionsupporting

confidence: 90%

“…The RCPL recommends that NEWS values of >7 should prompt assessment by an RRT (9). NEWS demonstrates better ability than other published EWSS to discriminate patients at risk of a range of clinical outcomes (6) and has been validated outside its development site (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…A recent study comparing the performances of NEWS and one set of MET criteria suggests that NEWS is a better (and earlier) detector of patient deterioration (13). Therefore, we used a large database of vital sign measurements to (a) compare the abilities of NEWS and 44 different MET criteria to discriminate patients at risk of four outcomes (i.e., cardiac arrest; unanticipated (i.e., emergency) ICU admission; death; or a combined outcome of any of these three) within 24 h of a vital signs dataset, and (b) measure the associated trigger rates.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

Smith

Prytherch

Jarvis

et al. 2016

Critical Care Medicine

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Interventions: None Measurements and Main Results:We applied NEWS and 44 sets of MET criteria to a database of 2,245,778 vital signs sets (103,998 admissions). NEWS' performance was assessed using the area under the receiveroperating characteristic (ROC) curve (AUROC) and compared with sensitivity/specificity for the different MET criteria. AUROC (95% CI) for NEWS for the combined outcome (i.e., death, cardiac arrest or unanticipated ICU admission) was 0.88 (0.88 -0.88). A NEWS value of 7 had sensitivity/specificity values of 44.5%/97.4%.For the 44 sets of MET criteria studied, sensitivity ranged from 19.6% to 71.2%, and specificity from 71.5% to 98.5%. For all outcomes, the position of the NEWS ROC curve was above and to the left of all MET criteria points, indicating better discrimination. Similarly, the positions of all MET criteria points were above and to the left of the NEWS efficiency curve, indicating higher workloads (trigger rates). Conclusions:When MET systems are compared to a NEWS value of >7, some MET systems have a higher sensitivity than NEWS values of >7. However, all of these MET systems have a lower specificity and would generate greater workloads.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

Smith

Prytherch

Jarvis

et al. 2016

Critical Care Medicine

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“…It is also notable that the authors used simple dichotomized ("all or nothing") criteria for calling the MET team. Continuous scoring systems such as the modified EWS (MEWS) may be more accurate but may be more cumbersome for ward staff [16].It is important to acknowledge that a strategy of RRT implementation will result in higher ICU admission rates and workload [17]. This needs to be taken into account when allocating hospital resources.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Finally time for rapid response systems to be well MET in Europe?

Skrifvars

Martín‐Loeches²

2016

Intensive Care Med

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Time is life. In medicine there are many "time-dependent" diseases: sepsis and cardiac arrest to name but two [1,2]. In order to improve patient outcome, it is imperative to define and characterize hospital workflows to facilitate good process of care. Several factors need to be synchronized, including coordination between different departments in the hospital [3]. Early communication and a multidisciplinary approach can dramatically change the management of patients. The goal of modern intensive care medicine is to optimize and maximize quality of patient care. It is desirable to foster an overview of the process of critical care and base it on clinical need of patients and less on hospital location. Clinical management and monitoring of severely ill patients before admission to intensive care units (ICU) have frequently been shown to be suboptimal [4,5]. Delays in patient admission to ICU are associated with a longer hospital stay and worse outcome. Recently, Harris et al. prospectively analysed the outcome of a large UK population from 48 hospitals and concluded that the deteriorating ward patient has a high short-term mortality; however, with early ICU admission an impressive 50 % reduction of 90-day mortality is possible [6].Clinical conditions at risk are usually preceded by pathophysiological alterations that are both detectable and preventable. As early as the late 1990s, patient-atrisk teams, medical emergency teams (METs) or rapid response teams (RRT) were created to early detect patients at risk on general wards [7]. In the USA, the Institute for Healthcare Improvement (IHI) recommended, more than 10 years ago, that hospitals should implement RRTs and/or METs for the identification of non-ICU patients at risk of deterioration [8,9].Meta-analyses, including 30 before-after studies, cohort studies and cluster randomized trials found that implementation of an RRT/MET is associated with a reduction in non-ICU cardiopulmonary arrests but the effect on hospital mortality is less clear [10,11]. In the UK, early warning scores (EWS) based on "track and trigger" systems have for several years been used to flag and alert patients at risk and develop a rapid response by in-hospital teams with critical care skills to stabilize patients and expedite admission to ICU [12].Thus far the evidence on MET/RRT adoption has mainly originated from outside continental Europe [13]. In a recent article in Intensive Care Medicine, Jung and colleagues retrospectively analysed patients' outcomes after RRT implementation in one hospital (RRT hospital) and compared these to outcomes from three other hospitals (non-RRT hospitals) in the south of France [14]. In essence, the authors replicated a system that was developed 25 years ago and recommended by current resuscitation guidelines [15]. The study showed an impressive decrease in hospital mortality in the hospital with RRT implementation. There are not many interventions in ICU that can be attributed to a similar decrease in mortality and the authors should be congratulated for s...

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Cardiac Arrest in the Intensive Care Unit

Tirkkonen

Efendijev

Skrifvars

2019

Annual Update in Intensive Care and Emergency Medicine 2019

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Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score

Abstract: NEWS discriminates high risk patients in a heterogenic general ward population independently of multiple confounding factors. The conventional dichotomised activation criteria were not able to detect high risk patients.

Cited by 42 publications

References 38 publications

A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

Finally time for rapid response systems to be well MET in Europe?

Cardiac Arrest in the Intensive Care Unit

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