Changes and their prognostic implications in the abbreviated VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients ?

BackgroundIt is not known how often, to what extent and over what time frame any early warning scores change in surgical patients, and what the implications of these changes are.SettingThunder Bay Regional Health Sciences Centre, Ontario, Canada.MethodsThe changes in the first three recordings of the abbreviated version of the VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients, and their relationship to subsequent in-hospital mortality were examined.ResultsIn the 2.0 SD 2.4 h between admission and the second recording the score changed in 12.6% of patients. If the initial abbreviated ViEWS was =2 points (78% of all patients) the in-hospital mortality was 0.5%, and not significantly different in the 3.7% of patients that either increased or decreased their score. Patients who had an initial score =3 had a significantly higher overall in-hospital mortality (odds ratio 5.48, Chi-square 120.72, p < 0.0001). Of these patients, those with a lower second score (42.3% of patients) had a significantly lower in-hospital mortality than those with an unchanged second score (i.e. 1.5% versus 3.3%, odds ratio 0.43, Chi-square 11.08, p < 0.001).ConclusionThe abbreviated ViEWS score measured on admission identifies the majority of surgical patients who are at low risk of in-hospital death. Patients with an initial abbreviated ViEWS =3 who do not reduce their score within 2–3 h of admission have a further significantly increased mortality.