Early Warning Score 02 for predicting the ventilatory requirement in patients with dyspnea presenting to the emergency department: a prospective observational study

Clinical deterioration of patients is often preceded by worsening vital signs. If identified early and acted upon quickly, it is conjectured that further deterioration can be prevented. It is a system to identify at-risk patients early, and a treatment protocol to escalate care appropriately and determine the level of competency of the provider. Despite wide dissemination of Early Warning Scores and similar systems serious adverse events presaged by deteriorating vital signs continue to be a major source of morbidity. This is either due to inherent inadequacies of EWS, lack of adherence to the treatment protocol, or a combination of both. Many scoring systems are present all over the world to detect patient clinical worsening for example (National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS), and Cardiac Arrest Risk Triage (CART). These scores primarily aim to detect clinical deterioration in patients by tracking their vital signs, with high EWS scores triggering a response to prevent any potential clinical decline. It has been observed that patients’ vital signs usually change before any clinical deterioration. Consequently, if early and timely interventions are adequately performed, adverse outcomes for patients may be prevented. Warning scores provide a good and reliable source for pre-hospital settings and are easy to calculate and apply. In the NEWS scoring system, the score is calculated whether the oxygen requirement is there or not. However, it does not consider how much oxygen flow requirement is there. It takes the same score for a patient requiring oxygen flow of 2 L/min and 12 L/min. So, an accurate status of the patient is missed. The Early Warning Score O2 score includes the level of oxygen flow required to calculate the score. To assess the accuracy of a new tool Early Warning Score with O2 requirement may prove to be a better tool to predict clinical deterioration and will be easy to calculate and apply so that every healthcare professional can predict the outcome and intervene early to prevent the unfavourable outcome even in pre-hospital setting along with hospitalized and ICU setting. Designing an easily calculable score can benefit every level of healthcare and help triage patients who require mechanical ventilation. While anticipating the clinical deterioration the resources could be used in a well-versed manner.