Early warning scores
How do you know when patients are so ill that it's time to act? Emma Baines and N S Kanagasundaram explain
After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the ward and patients who are so sick that they need admission to the high dependency unit (for patients who need more intensive observation, treatment, and nursing care than provided in a general ward) or the intensive care unit (for patients whose conditions are life threatening, needing constant monitoring and support from equipment and drugs).
It is clinically intuitive that physiological deterioration precedes critical illness, but intuition is a blunt tool, especially in the hands of a newly qualified doctor. So how do junior doctors tell when a deteriorating patient needs more senior or specialist attention?
Early warning scoring systems aim to predict which patients are in need, allow preventive management, and determine who might need a step up to higher levels of care.1 It is as important to be able to