Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study

Background: Several physiological scoring systems (PSS) have been proposedfor identifying those at risk of deterioration. However, thechosen specific physiological values chosen and the scores allocatedhave not been prospectively validated. In this study, we investigatethe relative contributions of the ventilatory frequency, heartrate, arterial pressure, temperature, oxygen saturation, andconscious level to mortality in order to devise a robust scoringsystem. All data were collected on admission to the emergencyunit. Precise ‘intervention-calling scores’ couldthen be derived to trigger interventions. Methods: Our observational, population-based single-centred study tookplace in a 602-bedded district general hospital. Patients admittedto the emergency care unit at Worthing general hospital duringan initial study period between July and November 2003 (n =3184) and a further validation period between October and November2005 (n = 1102) were included. Results: Multivariate logistic regression analysis demonstrated thata ventilatory frequency 20 min^–1, heart rate 102 min^–1,systolic blood pressure 99 mm Hg, temperature <35.3°C,oxygen saturation 96%, and disturbed consciousness were associatedwith an increase in mortality. The Worthing PSS was developedfrom the regression coefficients associated with each variable.The model showed good discrimination with an area under thereceiver operating characteristic curve, 0.74, excluding ageas a variable. The discrimination of this system was significantlybetter than the early-warning scoring system. Conclusions: A simple validated scoring system to predict mortality in medicalpatients with precise ‘intervention-calling scores’has been developed.