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Physiologically Unstable Patient (PUP) Early Warning Score

Purpose: To evaluate a patient on a general hospital ward using the Physiologically Unstable Patient (PUP) early warning score of Robb and Seddon.

Description

Robb and Seddon reported an early warning score called the Physiologically Unstable Patient (PUP) score. This can help to identify a patient on a general ward who may require more aggressive management. The authors are from the University of Auckland and Counties Manukau District Health Board in New Zealand.


Patient selection: general ward

 

Parameters:

(1) body temperature in °C

(2) systolic blood pressure in mm Hg

(3) heart rate in beats per minute

(4) respiratory rate in breaths per minute

(5) CNS score

(6) urine output in mL per hour

 

Parameter

Finding

Points

body temperature

<= 35°C

2

 

35.1 to 38°C

0

 

38.1 to 38.4°C

1

 

>= 38.5°C

2

systolic blood pressure

<= 80 mm Hg

5

 

81 to 90 mm Hg

2

 

91 to 100 mm Hg

1

 

101 to 180 mm Hg

0

 

181 to 199 mm Hg

1

 

>= 200 mm Hg

2

heart rate

<= 40 beats per minute

2

 

41 to 49 beats per minute

1

 

50 to 90 beats per minute

0

 

91 to 120 beats per minute

1

 

121 to 139 beats per min

2

 

>= 140 beats per minute

5

respiratory rate

<= 8 breaths per minute

5

 

9 to 20

0

 

21 to 26

1

 

27 to 39

2

 

>= 40 breaths per minute

5

CNS score

alert

0

 

new confusion or agitation

1

 

responds to voice

1

 

responds to pain

2

 

unresponsive

5

urine output

<= 15 mL per hour

2

 

16 to 29 mL per hour

1

 

>= 30 mL per hour

0

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 24

• The higher the score the greater the physiologic instability.

• The response team is also called if there is serious concern about the patient for any reason or a cardiac arrest.

 

Score

Evaluation

0

status quo

1

inform and watch more closely

2 to 4

early signs of instability

5 or more

trigger response team

 

Others reasons to call for immediate assistance:

(1) rapid clinical deterioration or any sudden change in vital signs

(2) active bleeding

(3) respiratory distress

(4) drop in systolic blood pressure > 50 mm Hg

(5) sudden decline in the level of consciousness

(6) prolonged or repeated seizures

(7) severe hypoglycemia (critical value)


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Objective

ICD-10