Changes and their prognostic implications in the abbreviated Vitalpac™ early warning score (ViEWS) after admission to hospital of 18,853 acutely ill medical patients

BackgroundThe best performing early warning score is Vitalpac™ Early Warning Score (ViEWS). However, it is not known how often, to what extent and over what time frame any early warning scores change, and what the implications of these changes are.SettingThunder Bay Regional Health Sciences Center, Ontario, Canada.MethodsThe changes in the first three complete sets of the six variables required to retrospectively calculate the abbreviated version of ViEWS (that did not include mental status) after admission to hospital of 18,853 acutely ill medical patients, and their relationship to subsequent in-hospital mortality were examined.ResultsIn the 10.4 SD 20.1 (median 5.0) hours between admission and the second recording the score changed in only 5.9% of patients and these changes were of no prognostic value. By the time of the third recording 34.9 SD 21.7 (median 30.0) hours after admission a change in score was clearly associated with a corresponding change in in-hospital mortality (e.g. for patients with an initial score of 5 an increase between the first and third recording of ≥4 points was associated with an increased mortality (OR 6.5 95% CI 2.3–15.9, p < 0.00001), whereas a reduction of ≤−4 points was associated with a reduced mortality (OR 0.4 95% CI 0.2–0.9, p 0.03)).ConclusionAfter a median interval of 30 h both the initial abbreviated ViEWS recording and subsequent changes in it both predict clinical outcome. It remains to be determined what interventions during this time frame will improve patient outcomes.