title: A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes.
abstract: OBJECTIVE
  To compare the ability of medical emergency team criteria and the National Early Warning Score to discriminate cardiac arrest, unanticipated ICU admission and death within 24 hours of a vital signs measurement, and to quantify the associated workload.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A large U.K. National Health Service District General Hospital.
  
  
  METHODS
  Adults hospitalized from May 25, 2011, to December 31, 2013.
  
  
  METHODS
  None.
  
  
  RESULTS
  We applied the National Early Warning Score and 44 sets of medical emergency team criteria to a database of 2,245,778 vital signs sets (103,998 admissions). The National Early Warning Score's performance was assessed using the area under the receiver-operating characteristic curve and compared with sensitivity/specificity for different medical emergency team criteria. Area under the receiver-operating characteristic curve (95% CI) for the National Early Warning Score for the combined outcome (i.e., death, cardiac arrest, or unanticipated ICU admission) was 0.88 (0.88-0.88). A National Early Warning Score value of 7 had sensitivity/specificity values of 44.5% and 97.4%, respectively. For the 44 sets of medical emergency team criteria studied, sensitivity ranged from 19.6% to 71.2% and specificity from 71.5% to 98.5%. For all outcomes, the position of the National Early Warning Score receiver-operating characteristic curve was above and to the left of all medical emergency team criteria points, indicating better discrimination. Similarly, the positions of all medical emergency team criteria points were above and to the left of the National Early Warning Score efficiency curve, indicating higher workloads (trigger rates).
  
  
  CONCLUSIONS
  When medical emergency team systems are compared to a National Early Warning Score value of greater than or equal to 7, some medical emergency team systems have a higher sensitivity than National Early Warning Score values of greater than or equal to 7. However, all of these medical emergency team systems have a lower specificity and would generate greater workloads.
authors: 1Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK.2Department of Research & Development, Portsmouth Hospitals NHS Trust, Portsmouth, UK.3Centre for Healthcare Modelling & Informatics, School of Computing, University of Portsmouth, Portsmouth, United Kingdom.4Department of Health Sciences, University of York, York, United Kingdom.
authors: Gary B
authors: GB
authors: Smith
authors: David R
authors: DR
authors: Prytherch
authors: Stuart
authors: S
authors: Jarvis
authors: Caroline
authors: C
authors: Kovacs
authors: Paul
authors: P
authors: Meredith
authors: Paul E
authors: PE
authors: Schmidt
authors: Jim
authors: J
authors: Briggs
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom; D055986:Vital Signs