Gielen et al used an early warning score (EWS) to evaluate a patient admitted to a general hospital ward. A high-risk patient is at greater risk for admission to the intensive care unit (ICU) and had a greater mortality. The authors are from Gelderse Vallei Hospital and Wageningen University in The Netherlands.
Patient selection: adult (>= 18 years of age) admitted to a general hospital ward
Evaluation: on admission
Parameters:
(1) use of supplemental oxygen
(2) oxygen saturation in percent
(3) respiratory rate in breaths per minute
(4) heart rate in beats per minute
(5) systolic blood pressure in mm Hg
(6) level of consciousness (AVPU) and/or delirium
(7) temperature °C
(8) blood lactate in mmol/L
(9) urine output in mL in last hour
Parameter
Finding
Points
supplemental oxygen
no
0
yes
2
oxygen saturation
>= 96
0
94 to 95
1
92 to 93
2
<= 91
3
respiratory rate
<= 8
3
9 to 11
1
12 to 20
0
21 to 24
2
>= 25
3
heart rate
<= 40
3
41 to 50
1
51 to 100
0
101 to 110
1
111 to 130
2
>= 131
3
systolic blood pressure
<= 90
3
91 to 100
2
101 to 110
1
111 to 219
0
>= 220
3
level of consciousness
alert (A)
0
delirium
2
VPU
3
temperature
<= 35
3
35.1 to 36
1
36.1 to 38
0
38.1 to 39
1
>= 39.1
2
lactate
< 2
0
2 to 2.99
2
3 to 3.99
3
>= 4
4
urine output
>= 15 mL
0
< 15 mL
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 26
Total Score
Risk Level
0 to 5
low
6 to 8
medium
>= 9
high
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