Changes in vital signs of hospitalized patients may not identify the need to escalate care as well as other bedside observations

Background Most Rapid Response Team activations rely on vital signs, frequently aggregated into weighted scoring systems, such as the National Early Warning Score (NEWS). Nevertheless, a substantial proportion of avoidable in-hospital deaths still result from delayed recognition of evolving pathophysiology and under-appreciation of patient or family concerns. Aim To compare the performance of NEWS with observations that can be rapidly assessed at the bedside without equipment or calculation, using death within 24 hours as a surrogate marker for patients requiring immediate attention. Methods Retrospective analysis of data collected prospectively on Rapid Response Team arrival to 4,581 adult patients in general medical, surgical, or intermediate care units at a 450-bed regional medical center in California, USA. Results Eight observations were identified that required no equipment to assess, which had a significant association with 24-hour mortality; ranked by adjusted odds ratio these were 1) jaundice, 2) need for supplemental oxygen, 3) capillary refill time, 4) part or all of the body feeling cold, 5) objectively distressed breathing, 6) altered mentation, 7) dry skin, and 8) cyanosis. A logistic regression model of these 8 variables had a significantly higher discrimination for death within 24 hours of Rapid Response Team arrival than NEWS (i.e., AUC of 0.790 SE 0.014 versus 0.707 SE 0.020, p <0.0001). Conclusion In patients who trigger a Rapid Response Team call, bedside information that can be obtained rapidly without equipment or calculation, may provide earlier and more reliable signals of illness severity than NEWS and other early warning scores based on traditional vital signs.