Austen Charlotte, Patterson Caroline, Poots Alan, Green Stuart, Weldring Theresa, Bell Derek
St George’s, University of London, UK.
Acute Med. 2012;11(2):66-73.
Chelsea and Westminster Hospital introduced the Chelsea Early Warning Score (CEWS) in 2007 to aid the recognition of acutely unwell patients. The Royal College of Physicians subsequently recommended a National Early Warning Score (NEWS) for implementation across the NHS. The aim of this study was to evaluate local adherence to CEWS to identify potential obstacles to the consistent implementation of NEWS.
Emergency Department (ED) and Acute Assessment Unit (AAU) notes were retrospectively reviewed for a convenience sample of 102 patients admitted to the AAU. Outcome measures were completeness of documentation of CEWS parameters, documentation and accuracy of aggregate CEWS scores. Aggregate NEWS scores were calculated from the documented observations and the calculated CEWS and NEWS scores were compared.
Physiological observations were documented for all patients attending the ED and AAU. Heart rate, blood pressure, respiratory rate, oxygen saturation and conscious level were documented in over 95% of ED and AAU patients. Urine output was recorded for only 48% of ED and 69% of AAU patients. Aggregate CEWS scores were documented for 66% of ED and 84% of AAU patients. These were calculated accurately in 73% of ED and 79% of AAU patients. Calculation errors were eleven times more likely to result in under-scoring than over-scoring. NEWS scores were significantly higher than CEWS for the same observations and would have resulted in a 71% increase in patients requiring escalation of care in the ED and a 116% increase in AAU.
Concerns highlighted with CEWS were the incomplete and inaccurate recording of aggregate scores, with underscoring resulting in the potential failure to recognise deteriorating patients. It is anticipated that NEWS will be accompanied by standardised documentation and training across the NHS which will support more complete and accurate recording of physiological data. Furthermore, NEWS appears from this study to be more sensitive than CEWS, thereby minimising the chance of missed deterioration.
切尔西和威斯敏斯特医院于2007年引入了切尔西早期预警评分（CEWS），以帮助识别病情严重的急性患者。英国皇家内科医师学院随后推荐了一项全国早期预警评分（NEWS），以便在国民保健服务体系（NHS）中实施。本研究的目的是评估对CEWS的本地依从性，以确定在一致实施NEWS方面的潜在障碍。
对入住急性评估单元（AAU）的102例患者的便利样本进行回顾性审查，这些患者来自急诊科（ED）和AAU的病历。结果指标包括CEWS参数记录的完整性、汇总CEWS评分的记录和准确性。根据记录的观察结果计算汇总NEWS评分，并比较计算出的CEWS和NEWS评分。
对所有到急诊科和急性评估单元就诊的患者都进行了生理观察记录。超过95%的急诊科和急性评估单元患者记录了心率、血压、呼吸频率、血氧饱和度和意识水平。只有48%的急诊科患者和69%的急性评估单元患者记录了尿量。66%的急诊科患者和84%的急性评估单元患者记录了汇总CEWS评分。其中73%的急诊科患者和79%的急性评估单元患者计算准确。计算错误导致得分过低的可能性是得分过高的11倍。对于相同的观察结果，NEWS评分显著高于CEWS评分，这将导致急诊科需要升级护理的患者增加71%，急性评估单元增加116%。
CEWS突出的问题是汇总评分记录不完整和不准确，得分过低可能导致无法识别病情恶化的患者。预计NEWS将伴随着国民保健服务体系的标准化记录和培训，这将有助于更完整、准确地记录生理数据。此外，从本研究来看，NEWS似乎比CEWS更敏感，从而将错过病情恶化的可能性降至最低。
