Changes in vital signs of hospitalized patients may not identify the need to escalate care as well as other bedside observations
5 affiliations
- 1Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, 4150 V Street, Suite 3400, University of California, Davis, Sacramento, CA 95817, United States
- 2Kaweah Delta Health, 400 W. Mineral King Ave, Visalia, CA 93291, United States
- 3Kritikus Foundation, Redding, CA, United States
- 4School of Clinical and Biomedical Sciences, University of Greater Manchester, Deane Road, Bolton BL3 5AB, United Kingdom
- 5Strategic Innovations, Orlando Health, 1126 S. Division Ave, Orlando, FL 328056, United States
Abstract
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 h as a surrogate marker for patients requiring immediate attention.
Methods: Retrospective analysis of data collected prospectively on Rapid Response Team arrival to 4581 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-h 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 h 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.
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BibTeX
@article{sebat2026changes,
title = {{Changes in vital signs of hospitalized patients may not identify the need to escalate care as well as other bedside observations}},
author = {Christian Sebat and Frank Sebat and John Kellett and Daleen Penoyer},
journal = {Resuscitation Plus},
year = {2026},
month = oct,
doi = {10.1016/j.resplu.2026.101529},
url = {https://doi.org/10.1016/j.resplu.2026.101529},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Changes in vital signs of hospitalized patients may not identify the need to escalate care as well as other bedside observations
AU - Christian Sebat
AU - Frank Sebat
AU - John Kellett
AU - Daleen Penoyer
PY - 2026
DA - 2026/10/10
JO - Resuscitation Plus
DO - 10.1016/j.resplu.2026.101529
UR - https://doi.org/10.1016/j.resplu.2026.101529
AB - 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 h as a surrogate marker for patients requiring immediate attention. Methods: Retrospective analysis of data collected prospectively on Rapid Response Team arrival to 4581 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-h 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 h 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.
SN - 2666-5204
ER -