Tam et al reported the Hamilton Early Warning Score (HEWS) for identifying inpatients with a critical event. This can help to identify a patient who should be evaluated by a rapid response team.
Patient selection: hospital inpatient adult
Critical event: inpatient death, inpatient arrest, ICU transfer
Parameters:
(1) heart rate in beats per minute
(2) systolic blood pressure in mm Hg
(3) respiratory rate in breaths per minute
(4) temperature in °C
(5) oxygen saturation in percent
(6) oxygen delivery
(7) neurologic status, including the Confusion Assessment Method (CAM)
|
Parameter |
Finding |
Points |
|
heart rate |
<= 40 beats per minute |
2 |
|
|
41-50 beats per minute |
1 |
|
|
51 to 100 beats per minute |
0 |
|
|
101 to 110 beats per minute |
1 |
|
|
111 to 130 beats per minute |
2 |
|
|
>= 131 |
3 |
|
systolic blood pressure |
<= 70 mm Hg |
3 |
|
|
71 to 90 mm Hg |
2 |
|
|
91 to 170 mm Hg |
0 |
|
|
171 to 200 mm Hg |
2 |
|
|
> 200 mm Hg |
3 |
|
respiratory rate |
< 8 |
3 |
|
|
8 to 13 |
2 |
|
|
14 to 20 |
0 |
|
|
21 to 30 |
2 |
|
|
> 30 |
3 |
|
temperature |
<= 35°C |
3 |
|
|
35.1 to 36.4°C |
1 |
|
|
36.5 to 38.0°C |
0 |
|
|
38.1 to 39.0°C |
1 |
|
|
>= 39.1°C |
2 |
|
oxygen saturation |
< 85 percent |
3 |
|
|
85 to 91 percent |
1 |
|
|
>= 92 percent |
0 |
|
oxygen delivery |
room air |
0 |
|
|
<= 5 L/min |
1 |
|
|
<= 50% by mask |
1 |
|
|
> 5 L/min |
3 |
|
|
> 50% by mask |
3 |
|
neurologic status |
alert |
0 |
|
|
CAM positive |
2 |
|
|
responds to voice |
1 |
|
|
responds to pain |
2 |
|
|
unresponsive to all stimuli |
3 |
HEWS score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the more serious the patient's condition.
|
HEWS |
Risk Group |
Likelihood Ratio for a Critical Event |
|
0 to 2 |
low risk |
0.56 |
|
3 to 5 |
moderate risk |
1.8 |
|
6 to 8 |
high risk |
8.0 |
|
>= 9 |
very high risk |
16.7 |
