The Admission Hamilton Early Warning Score (HEWS) Predicts the Risk of Critical Event during Hospitalization

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Benjamin Tam BHSc MD
Michael Xu BHSc
Michelle Kwong BHSc Cand.
Christine Wardell BHSc Cand.
Andrew Kwong BHSc Cand.
Alison Fox-Robichaud MSc MD FRCPC


Background: Early warning scores detect patients at risk of deterioration in hospital. Our objective was to first, demonstrate that the admission Hamilton Early Warning Score (HEWS) predicts critical events and second, estimate the workload required to identify critical events during hospitalization.
Methods: We prospectively identified a consecutive cohort of medical/surgical patients for retrospective review. Critical events were defined as a composite of inpatient death, cardio-pulmonary arrest or ICU transfer. Likelihood of a critical event during hospitalization and the number needed to evaluate to detect a critical event was based on highest admission HEWS.
Results: We found 506 critical events occurred in 7130 cases. HEWS identified graduated levels of risk at admission. We found 2.6 and 1.8 patients needed to be evaluated in the ‘high-risk’ and very ‘high-risk’ subgroups to detect a critical event.
Conclusions: HEWS identified patients at risk for critical events during hospitalization at ward admission. Few patients with high HEWS required evaluation to detect a critical event.
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