Modified early warning score with rapid lactate level in critically ill medical patients: the ViEWS-L score

Abstract

The ViEWS-L score performed as well as or better than the pre-existing risk scoring systems in predicting mortality in critically ill medical patients who were admitted to the medical intensive care unit via the ED.

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

“…Our results may be explained by reduced severity of illness or greater heterogeneity of cases in our sample compared to previous cohorts, or alternatively, the modest incidence of the primary outcome measure (4.4%). Whilst our sample size was more than twice as large as the only other study of this type, our event rate was lower [15]. Nonetheless, our statistical methods are appropriate for the event rate and sample size.…”

“…We did not identify association between lactate and clinical outcome [15,19]. We considered lactate as a continuous variable, but we also repeated the analysis using categorical values (<2.5, 2.5-4.0 and >4.0mmol/L) and our results were unchanged.…”

“…However, the methods, which use both simple addition and multivariable logistic regression modelling to create composite scores, are unclear [15]. To take account of the uncertainty in their methodology, we tested both approaches to combine NEWS and the three chosen biomarkers.…”

“…[15] We used this approach to create a set of composite scores by adding the absolute values of admission NEWS to each of lactate, glucose or base excess. To determine whether these composite scores were associated with the primary outcome we repeated the regression analyses using these variables.…”

“…Limited evidence suggests that the addition of serum lactate to EWS improved association with clinical outcome, compared to EWS alone [15]. However, it is unknown whether lactate or other blood gas variables could improve the utility of NEWS, in predicting clinical outcome [15].…”