title: Centile-based early warning scores derived from statistical distributions of vital signs.
abstract: OBJECTIVE
  To develop an early warning score (EWS) system based on the statistical properties of the vital signs in at-risk hospitalised patients.
  
  
  METHODS
  A large dataset comprising 64,622 h of vital-sign data, acquired from 863 acutely ill in-hospital patients using bedside monitors, was used to investigate the statistical properties of the four main vital signs. Normalised histograms and cumulative distribution functions were plotted for each of the four variables. A centile-based alerting system was modelled using the aggregated database.
  
  
  RESULTS
  The means and standard deviations of our population's vital signs are very similar to those published in previous studies. When compared with EWS systems based on a future outcome, the cut-off values in our system are most different for respiratory rate and systolic blood pressure. With four-hourly observations in a 12-h shift, about 1 in 8 at-risk patients would trigger our alerting system during the shift.
  
  
  CONCLUSIONS
  A centile-based EWS system will identify patients with abnormal vital signs regardless of their eventual outcome and might therefore be more likely to generate an alert when presented with patients with redeemable morbidity or avoidable mortality. We are about to start a stepped-wedge clinical trial gradually introducing an electronic version of our EWS system on the trauma wards in a teaching hospital.
authors.affiliation: Institute of Biomedical Engineering, Old Road Campus Research Building (Off Roosevelt Drive), University of Oxford, Oxford OX3 7DQ, UK. lionel.tarassenko@eng.ox.ac.uk
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
authors.forename: David A
authors.initials: DA
authors.lastname: Clifton
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: Marilyn T
authors.initials: MT
authors.lastname: Hravnak
authors.forename: John R
authors.initials: JR
authors.lastname: Woods
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Watkinson
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D016638:Critical Illness; D042241:Early Diagnosis; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D056152:Respiratory Rate / Q000502:physiology; D016008:Statistical Distributions; D055986:Vital Signs
chemical_list: D010100:Oxygen