title: A critical assessment of early warning score records in 168,000 patients.
abstract: The national early warning score (NEWS) is recommended to detect deterioration in hospitalised patients. In 2013, a NEWS-based system was introduced in a hospital service with over 250,000 annual admissions, generating large amounts of NEWS data. The quality of such data has not been described. We critically assessed NEWS data recorded over 12 months. This observational study included NEWS records from adult inpatients hospitalized in the Capital Region of Denmark during 2014. Physiological variables and the use of supplementary oxygen (NEWS variables) were recorded. We identified implausible records and assessed the distributions of NEWS variable values. Of 2,835,331 NEWS records, 271,103 (10%) were incomplete with one or more variable missing and 0.2% of records containing implausible values. Digit preferences were identified for respiratory rate, supplementation oxygen flow, pulse rate, and systolic blood pressure. There was an accumulation of pulse rate records below 91 beats per minute. Among complete NEWS records, 64% had NEWS ≥ 1; 29% had NEWS ≥ 3; and 8% had NEWS ≥ 6. In a large set of NEWS data, 10% of the records were incomplete. In a system where data were manually entered into an electronic medical record, digit preferences and the accumulation of pulse rate records below 91 beats per minute, which is the limit for NEWS point generation, showed that staff practice influenced the recorded values. This indicates a potential limitation of transferability of research results obtained in such systems to fully automated systems.
authors.affiliation: Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, University of Copenhagen, 25th floor, Herlev Ringvej 75, 2730, Herlev, Denmark. niels.egholm.pedersen@regionh.dk.
authors.forename: Niels Egholm
authors.initials: NE
authors.lastname: Pedersen
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Lars Simon
authors.initials: LS
authors.lastname: Rasmussen
authors.affiliation: Department of Anaesthesia and Intensive Care, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
authors.forename: John Asger
authors.initials: JA
authors.lastname: Petersen
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
authors.forename: Thomas Alexander
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, University of Copenhagen, 25th floor, Herlev Ringvej 75, 2730, Herlev, Denmark.
authors.forename: Doris
authors.initials: D
authors.lastname: Østergaard
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Lippert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016477:Artifacts; D001331:Automation; D001831:Body Temperature; D003422:Critical Care; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D003718:Denmark; D057286:Electronic Health Records; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D010100:Oxygen / Q000378:metabolism; D056152:Respiratory Rate; D018570:Risk Assessment / Q000379:methods; D012815:Signal Processing, Computer-Assisted; D013599:Systole; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Archived data; EWS; Early warning score; NEWS; National early warning score; Patient monitoring; Physiologic monitoring; Vital signs