Progression of early warning scores (EWS) in patients with acute pancreatitis: a re-evaluation of a retrospective cohort of patients.
BACKGROUND
Early warning scores (EWS) is a physiological scoring system measured hourly. This study determined how progression of EWS affected outcome in acute pancreatitis.


METHODS
The single worst EWS score for each 24 h period following admission was recorded for 110 patients with acute pancreatitis. Scores falling below 3 were defined as improving; scores which remained at 3 or rising were considered deteriorating.


RESULTS
Deteriorating EWS values were associated with a greatly increased risk of mortality (p<0.001). All patients within the groups, who died, had an adverse outcome or had severe pancreatitis, demonstrated a failure to improve on a median admission EWS of >or=3 or a deterioration of their median EWS to above this. This progression occurred within 48 h of admission. Evaluating the progression of EWS (that is, improving or deteriorating scores) resulted in an improvement in the sensitivity and specificity in predicting adverse outcome, mortality or severe pancreatitis when compared to previously published data on EWS scores alone, on days 1 to 3 following admission.


CONCLUSIONS
Deteriorating EWS values within the 48 h from admission are associated with adverse outcome or death in acute pancreatitis. Measuring progression of EWS over 72 h from admission can further improve accuracy of this monitoring system for acute pancreatitis.
Department of Hepatobiliary & Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. gg43@le.ac.uk
G
G
Garcea
B
B
Jackson
C J
CJ
Pattenden
S L
SL
Ong
C P
CP
Neal
A R
AR
Dennison
D P
DP
Berry
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D042241:Early Diagnosis; D006801:Humans; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012720:Severity of Illness Index