Changes and their prognostic implications in the abbreviated VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients

Background: It is not known how often, to what extent and over what time frame any early warning scores change in surgical patients, and what the implications of these changes are. Setting: Thunder Bay Regional Health Sciences Centre, Ontario, Canada. Methods: The changes in the first three recordings of the abbreviated version of the VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients, and their relationship to subsequent in-hospital mortality were examined. Results: In the 2.0 SD 2.4. h between admission and the second recording the score changed in 12.6% of patients. If the initial abbreviated ViEWS was ≤2 points (78% of all patients) the in-hospital mortality was 0.5%, and not significantly different in the 3.7% of patients that either increased or decreased their score. Patients who had an initial score ≥3 had a significantly higher overall in-hospital mortality (odds ratio 5.48, Chi-square 120.72, p< 0.0001). Of these patients, those with a lower second score (42.3% of patients) had a significantly lower in-hospital mortality than those with an unchanged second score (i.e. 1.5% versus 3.3%, odds ratio 0.43, Chi-square 11.08, p< 0.001). Conclusion: The abbreviated ViEWS score measured on admission identifies the majority of surgical patients who are at low risk of in-hospital death. Patients with an initial abbreviated ViEWS ≥3 who do not reduce their score within 2-3. h of admission have a further significantly increased mortality.