Evidence map›Paper›PMID 31915173›Full record

ArticleBMJ open2020

Adjusting Early Warning Score by clinical assessment: a study protocol for a Danish cluster-randomised, multicentre study of an Individual Early Warning Score (I-EWS).

Pernille B Nielsen, Martin Schultz, Caroline Sophie Langkjaer, Anne Marie Kodal, Niels Egholm Pedersen, John Asger Petersen, Theis Lange, Michael Dan Arvig, Christian Sahlholt Meyhoff, Morten Bestle and 6 more

Registry-linked trialOpen access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03690128 (Individual Early Warning Score), which is not on this map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.2field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

NCT03690128 nacompletednot on this map

Individual Early Warning Score (I-EWS) - Does Clinical Assessment Improve Detection of Acute Deterioration in Hospitalized Patients - a Cluster-randomized Trial

TypeinterventionalSponsorHerlev HospitalRan2018 to 2019Enrolled150,000ConditionsEarly Warning Score, Risk StratificationArmsI-EWS with incorporated clinical assessment (Trigger Tool), Standard EWS - Control (Trigger Tool)
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 14 citations in OpenAlex.

  1. Article
  2. [Early warning scores: a rapid umbrella review].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 5 institutions in 2 countries.

Pernille B NielsenDepartment of Emergency Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark pernille.brok.nielsen@regionh.dk.ORCID 0000-0003-3762-8590
Martin SchultzDepartment of Emergency Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
Caroline Sophie LangkjaerDepartment of Emergency Medicine, Nordsjaellands Hospital, Hillerod, Denmark.
Anne Marie KodalDepartment of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark.
Niels Egholm PedersenDepartment of Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
John Asger PetersenDepartment of Day Surgery, Amager and Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Theis LangeDepartment of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Michael Dan ArvigDepartment of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
Christian Sahlholt MeyhoffDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Morten BestleDepartment of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark.
Bibi Hølge-HazeltonResearch Support Unit, Zealand University Hospital Roskilde, Roskilde, Denmark.
Gitte BunkenborgDepartment of Anesthesiology, Holbaek Hospital, Holbaek, Denmark.
Anne LippertCopenhagen Academy for Medical Education and Simulation, Herlev, Denmark.
Ove AndersenDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Lars Simon RasmussenDepartment of Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Kasper Karmark IversenDepartment of Emergency Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
University of Copenhagen · DKNordsjællands Hospital · DKCopenhagen Academy for Medical Education and Simulation · DKHolbæk Sygehus · DKUniversity of Southern Denmark · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTrack and trigger systems (TTSs) based on vital signs are implemented in hospitals worldwide to identify patients with clinical deterioration. TTSs may provide prognostic information but do not actively include clinical assessment, and their impact on severe adverse events remain uncertain. The demand for prospective, multicentre studies to demonstrate the effectiveness of TTSs has grown the last decade. Individual Early Warning Score (I-EWS) is a newly developed TTS with an aggregated score based on vital signs that can be adjusted according to the clinical assessment of the patient. The objective is to compare I-EWS with the existing National Early Warning Score (NEWS) algorithm regarding clinical outcomes and use of resources. METHOD AND ANALYSIS: In a prospective, multicentre, cluster-randomised, crossover, non-inferiority study. Eight hospitals are randomised to use either NEWS in combination with the Capital Region of Denmark NEWS Override System (CROS) or implement I-EWS for 6.5 months, followed by a crossover. Based on their clinical assessment, the nursing staff can adjust the aggregated score with a maximum of -4 or +6 points. We expect to include 150 000 unique patients. The primary endpoint is all-cause mortality at 30 days. Coprimary endpoint is the average number of times per day a patient is NEWS/I-EWS-scored, and secondary outcomes are all-cause mortality at 48 hours and at 7 days as well as length of stay. ETHICS AND DISSEMINATION: The study was presented for the Regional Ethics committee who decided that no formal approval was needed according to Danish law (J.no. 1701733). The I-EWS study is a large prospective, randomised multicentre study that investigates the effect of integrating a clinical assessment performed by the nursing staff in a TTS, in a head-to-head comparison with the internationally used NEWS with the opportunity to use CROS. TRIAL REGISTRATION NUMBER: NCT03690128.

Indexed as

Early Warning ScoreNursing AssessmentNursing Staff, HospitalAlgorithmsCause of DeathClinical DeteriorationCross-Over StudiesDenmarkEquivalence Trials as TopicHospital MortalityHumansLength of StayMulticenter Studies as TopicPrognosisProspective StudiesRandomized Controlled Trials as Topicclinical deteriorationearly warning scoresemergency medicinehealth and safetyrapid response systemsrisk management

Identifiers

PMID31915173
PMCPMC6955532
OpenAlexW2999943559

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.