James GriffithsConsultant EM

BarnsleyCEM FOAMed Network

@YorksHumberFoam

Objectives Evolution of Early Warning Scores Rapid Emergency Medicine Score (REMS) National Early Warning Score (NEWS) EWS in the ED Future work? Conclusion

First EWSDeveloped in 1997

by Morgan et alBased on five

physiological parameters:SBPPulseResp rateTempAVPU

Morgan et al. Clin Intensive Care 1997;8:100

M(odified)EWSSurgical patients

Deviation from normal BP

Urine outputPotential benefit

from critical care

Stenhouse et al. Br J Anaesth 2000;84:663

Patients at riskScore

3 2 1 0 1 2 3

SBP <70 71-80 81-100

101-199

≥200

HR <40 41-50 51-100 101-110

111-129

≥130

RR <9 9-14 15-20

21-29

≥30

Temp <35 35-38.4

≥38.5

AVPU Alert Voice

Pain Un-responsive

Subbe et al. Q J Med 2001;94:521-526

REMS0 1 2 3 4 5 6

Age <45 45-54 55-64 65-74 >74

HR 70-109 55-69110-139

40-54140-179

<40>179

RR 12-24 10-1125-34

6-9 35-49 >49

SBP 90-129 70-89130-149

150-179

<69>179

GCS >13 11-13 8-10 5-7 <5

O2 >89 86-89 75-85 <75

Olsson & Lind. Acad Emerg Med 2003;10:1040-1048

NICEThe National Institute for Health and Clinical

Excellence (NICE) have recommended that physiological track and trigger systems should be used to monitor all adult patients in acute hospital settings

NICE Clinical Guideline 50 (2007)

DoH Clinical IndicatorsThe new Department of Health Quality

Indicators that will replace the four-hour standard record a time to full initial assessment of patients attending EDs which includes a pain score and early warning score in patients arriving by 999 ambulance

Department of Health 2011

NEWSRoyal College of

Physicians working party July 2012

Based on a large number of vital signs from an electronic patient database

Prytherch et al. Resuscitation 2010. 81:932-937

Smith et al. Resuscitation 2013. 84:465-470

The Future?

Smith et al. Resuscitation 2013. 84:465-470