This compares favourably with our earlier, more complicated, 16-item score [4].Several additional findings suggest that the Bedside PEWS is a good measure of severity of illness. First, the Bedside PEWS score increased over time leading up to ICU admission. This finding is consistent ZD6474 with observations in other populations, [18] and indicates the Bedside PEWS score is responsive to changes in clinical condition over time in patients �C specifically the clinical deterioration associated with evolving critical illness (Figure (Figure2).2). Scores were greatest in the last 12 hours before urgent ICU admissions. Scores in the 12 to 24 hours before urgent ICU admission were 5.3 to 6.0, values that were higher than we found in ‘well’ control patients.

Second, the ability of the Bedside PEWS score to prospectively distinguish critically ill from well patients was as good �C if not superior to �C the retrospective opinion of the bedside nurses who cared for these patients (AUCROC 0.84). The inclusion of both nurse rating and the Bedside PEWS score increased the AUCROC from 0.91 to 0.94. These data suggest that the Bedside PEWS score may provide objective real-time data to compliment frontline provider knowledge, and to better inform level of care and management decision-making [19-21].Third, the time to the planned review of patients seen by the ICU team is a prospectively articulated marker of the risk of clinical deterioration manifest as near or actual cardiopulmonary arrest. We found patients with higher Bedside PEWS scores had shorter time to planned review (P = 0.034).

Concordance between the Bedside PEWS score and the prospective management plan of a team with critical care expertise further suggests that the Bedside PEWS score is a good measure of severity of illness.Implications for the use of Bedside PEWSOur data suggest that early identification of patients with evolving critical illness by the Bedside PEWS may permit the targeted application of intermediate response strategies (increased intensity of observation and management), mitigate clinical deterioration and prevent ICU admission, rather than waiting for a ‘trigger’ to call the ICU team for urgent pre-arrest management [5,22]. Previous experience from the negative cluster randomised trial of medical emergency teams underscores the importance of appropriate mechanisms to identify patients at risk. In this study of 120,000 patients, less than half of patients who had a cardiac arrest, unplanned ICU admission or unexpected death, met calling criteria more than 15 minutes before their event [23]. In contrast more than 80% of patients were identified with at least one hours notice in this GSK-3 study of the Bedside PEWS score.