Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they [...]

Background: The Modified Early Warning Score (MEWS) is a physiological scoring system developed to identify patients in early stages of clinical deterioration and prevent delays in proper care. It consists of systolic blood pressure, heart rate, respiratory rate, temperature and level of consciousness. Higher MEWS are associated with greater mortality and need for intensive care. [...]

Background: Early warning scores are clinical decision support tools that incorporate multiple physiologic variables to detect patient deterioration. Previous studies have highlighted the value of integrating measures of provider intuition into predictive models. (1-3) For example, incorporating the Patient Acuity Rating, a Likert-based measure of nurse worry, into the six-variable Modified Early Warning Score (MEWS) [...]

Background: Despite the introduction of Early Warning Scores (EWSs), clinical deterioration (CD) remains an actual problem on the general ward. A next step to counter CD would be to intensify measurement from intermittent 8 hours to continuous measurements. This leads to big data sets of patient monitoring data with great potential. Use of advanced predictive [...]

Background: About 209,000 adults experience an in-hospital cardio-pulmonary arrest (IHCA) every year in the US. Known early warning scoring systems (e.g., MEWS, eCART) have shown low efficiency in predicting a patient’s risk of deterioration. We assessed the possibility of using the Rothman Index (RI) as such a tool. Methods: We conducted a retrospective case-control study with 248 adult inpatients at Yale-New [...]

Background: An important duty of every hospitalist is to detect the earliest signs of imminent clinical deterioration. Breathing motion patterns can convey early warnings of respiratory instability (1). Normal breathing appears regular, effortless, well-coordinated and comfortable (2). In patients at high risk of respiratory deterioration, breathing appears labored (3). Well-established signs of labored breathing include: [...]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they [...]