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Logistic early warning scores to predict death, cardiac arrest or unplanned intensive care unit re-admission after cardiac surgery.

Published version
Peer-reviewed

Type

Article

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Authors

Villar, SS 
Brand, JW 
Patteril, MV 
Morrice, DJ 

Abstract

NHS England recently mandated that the National Early Warning Score of vital signs be used in all acute hospital trusts in the UK despite limited validation in the postoperative setting. We undertook a multicentre UK study of 13,631 patients discharged from intensive care after risk-stratified cardiac surgery in four centres, all of which used VitalPACTM to electronically collect postoperative National Early Warning Score vital signs. We analysed 540,127 sets of vital signs to generate a logistic score, the discrimination of which we compared with the national additive score for the composite outcome of: in-hospital death; cardiac arrest; or unplanned intensive care admission. There were 578 patients (4.2%) with an outcome that followed 4300 sets of observations (0.8%) in the preceding 24 h: 499 out of 578 (86%) patients had unplanned re-admissions to intensive care. Discrimination by the logistic score was significantly better than the additive score. Respective areas (95%CI) under the receiver-operating characteristic curve with 24-h and 6-h vital signs were: 0.779 (0.771-0.786) vs. 0.754 (0.746-0.761), p < 0.001; and 0.841 (0.829-0.853) vs. 0.813 (0.800-0.825), p < 0.001, respectively. Our proposed logistic Early Warning Score was better than the current National Early Warning Score at discriminating patients who had an event after cardiac surgery from those who did not.

Description

Keywords

ICU re-admission, cardiac surgery, early warning scores, logistic regression, postoperative deterioration, Cardiac Surgical Procedures, Early Warning Score, Heart Arrest, Humans, Intensive Care Units, Patient Readmission, Predictive Value of Tests, Reproducibility of Results, Sensitivity and Specificity, United Kingdom

Journal Title

Anaesthesia

Conference Name

Journal ISSN

0003-2409
1365-2044

Volume Title

75

Publisher

Wiley
Sponsorship
MRC (unknown)
MRC (unknown)
Biometrika Trust (unknown)