ArticleBMJ open2018
Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Applications of the Early Warning Score as an outcome measure: a systematic review of methodologies.BMJ health & care informatics · 2026Pooled it
- Pooled it
- Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology.BMJ (Clinical research ed.) · 2020Pooled it
- A retrospective records review comparing the care of patients who either avoided or were admitted to an ICU following a ward-based deterioration event.Intensive & critical care nursing · 2025Article
- Successfully initiating an escalation of care in acute ward settings-A qualitative observational study.Journal of advanced nursing · 2025Observational
- Real-world implementation of the National Early Warning Score-2 in an acute respiratory unit.BMJ open respiratory research · 2024Article
- Predicting outcome in acute respiratory admissions using patterns of National Early Warning Scores.Clinical medicine (London, England) · 2022Article
- Risk factors and medical resource utilization in US adults hospitalized with influenza or respiratory syncytial virus in the Hospitalized Acute Respiratory Tract Infection study.Influenza and other respiratory viruses · 2022Article
- Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study.JMIR formative research · 2022Article
- Evaluating the Efficacy of the National Early Warning Score in Predicting the Mortality of Stroke Patients Admitted to Intensive Care Units.Anesthesiology and pain medicine · 2022Article
- A qualitative exploration of escalation of care in the acute ward setting.Nursing in critical care · 2020Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 3 countries.
Funding
Abstract
objectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.
designRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.
settingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds. OUTCOME MEASURES: Projected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.
results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.
conclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.
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Registered trials
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