Clinical paperLongitudinal analysis of one million vital signs in patients in an academic medical center☆
Introduction
Rapid response teams have been implemented in a number of hospitals for assistance with the care of critically ill patients. The designation of particular vital signs as “triggers” for alerting rapid response teams have been derived from landmark studies in this field that were limited by relatively small datasets and often included only one measurement of vital signs1, 2 or measurement of vital signs only early in the hospital admission.3, 4, 5 Studying vital signs throughout the entire hospital stay is important because rapid response teams are called not only at admission, but at any time throughout the hospitalization.
The purpose of this study was to determine the prevalence and time of occurrence of critical vital signs throughout the hospital stay and examine their associated mortality. It was our intent to determine if the simultaneous occurrence of more than one critical vital sign at any time during the hospitalization was associated with in-hospital mortality and to validate prior scores.3, 6
In order to accomplish this, we were able to take advantage of the fact that vital signs at the medical center under study are entered electronically into a computer database. We were therefore able to analyze a very large amount of data (>1 million vital sign sets) in a large number of admissions (42,430). In addition, code status could be determined in individuals with the highest morbidity.
Section snippets
Methods
This was a retrospective study approved by the Wake Forest University School of Medicine Institutional Review Board.
Results
There were 1.15 million individual vital sign determinations obtained in 42,430 admissions on 27,722 patients between January 1, 2008 and June 30, 2009. A complete set of vital signs (level of consciousness, pulse oximetry reading, blood pressure, temperature, respiratory rate, and pulse) was present in 71.9% of measurements, and there was one missing vital sign out of 6 in 12.2%, 2/6 missing in 4.3%, 3–5/6 missing in 11.6%. The most common missing vital signs were temperature (17.8%) and pulse
Discussion
The simultaneous occurrence of three or more critical vital signs was more likely to occur early in the hospital admission (38% occurring within 48 h of admission), but could occur at any time, with 40% occurring greater than 5 days after admission. We found that a simple summation score of critical vital signs was highly predictive of in-hospital mortality. We were able to validate the MEWS and VIEWS as well, and show that these scores are predictive not only at the time of admission but also
Conflict of interest statement
There are no financial and/or personal relationships with other people or organizations that could inappropriately influence this work.
Acknowledgements
Funds were provided by Wake Forest University School of Medicine for statistical analysis of the data. The study sponsors did not participate in study design, data collection, analysis, interpretation of data or in the writing of the manuscript or the decision to submit the manuscript for publication. Work complies with the principles laid down in the Declaration of Helsinki.
References (11)
- et al.
Should age be included as a component of track and trigger systems used to identify sick adult patients?
Resuscitation
(2008) - et al.
ViEWS—towards a national early warning score for detecting adult inpatient deterioration
Resuscitation
(2010) - et al.
A review, and performance evaluation, of single-parameter “track and trigger” systems
Resuscitation
(2008) - et al.
The simple clinical score predicts mortality for 30 days after admission to an acute medical unit
Q J Med
(2006) - et al.
Physiological abnormalities in early warning scores are related to mortality in adult inpatients
Br J Anaesth
(2009)
Cited by (126)
Continuous remote monitoring in post–bariatric surgery patients: development of an early warning protocol
2022, Surgery for Obesity and Related DiseasesThe application of pediatric early warning score (PEWS) in emergency observation room
2022, Journal of Pediatric NursingContactless Patient Care Using Hospital IoT: CCTV-Camera-Based Physiological Monitoring in ICU
2024, IEEE Internet of Things JournalImportance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review
2024, Journal of Clinical Nursing
- ☆
A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.06.033.