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Vital signs, i.e. respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients. Changes in vital signs prior to clinical deterioration are well documented and early detection of preventable outcomes is key to timely intervention. Despite their role in clinical practice, how to best monitor and interpret them is still unclear. To evaluate the ability of vital sign trends to predict clinical deterioration in patients hospitalized with acute illness. PubMed, Embase, Cochrane Library and CINAHL were searched in December 2017. Studies examining intermittently monitored vital sign trends in acutely ill adult patients on hospital wards and in emergency departments. Outcomes representing clinical deterioration were of interest. Performed separately by two authors using a preformed extraction sheet. Of 7,366 references screened, only two were eligible for inclusion. Both were retrospective cohort studies without controls. One examined the accuracy of different vital sign trend models using discrete-time survival analysis in 269,999 admissions. One included 44,531 medical admissions examining trend in Vitalpac Early Warning Score weighted vital signs. They stated that vital sign trends increased detection of clinical deterioration. Critical appraisal was performed using evaluation tools. The studies had moderate risk of bias, and a low certainty of evidence. Additionally, four studies examining trends in early warning scores, otherwise eligible for inclusion, were evaluated. This review illustrates a lack of research in intermittently monitored vital sign trends. The included studies, although heterogeneous and imprecise, indicates an added value of trend analysis. This highlights the need for well-controlled trials to thoroughly assess the research question.

Early warning scores (EWS) are widely used in well-resourced healthcare settings to identify patients at risk of mortality. The Modified Early Warning Score (MEWS) is a well-known EWS used comprehensively in the United Kingdom. The HOTEL score (Hypotension, Oxygen saturation, Temperature, ECG abnormality, Loss of independence) was developed and tested in a European cohort; however, its validity is unknown in resource limited settings. This study compared the performance of both scores and suggested modifications to enhance accuracy. A prospective cohort study of adults (≥18 yrs) admitted to medical wards at a Malawian hospital. Primary outcome was mortality within three days. Performance of MEWS and HOTEL were assessed using ROC analysis. Logistic regression analysis identified important predictors of mortality and from this a new score was defined. Three-hundred-and-two patients were included. Fifty-one (16.9%) died within three days of admission. With a cut-point ≥2, the HOTEL score had sensitivity 70.6% (95% CI: 56.2 to 82.5) and specificity 59.4% (95% CI: 53.0 to 65.5), and was superior to MEWS (cut-point ≥5); sensitivity: 58.8% (95% CI: 44.2 to 72.4), specificity: 56.2% (95% CI: 49.8 to 62.4). The new score, dubbed TOTAL (Tachypnoea, Oxygen saturation, Temperature, Alert, Loss of independence), showed slight improvement with a cut-point ≥2; sensitivity 76.5% (95% CI: 62.5 to 87.2) and specificity 67.3% (95% CI: 61.1 to 73.1). Using an EWS generated in developed healthcare systems in resource limited settings results in loss of sensitivity and specificity. A score based on predictors of mortality specific to the Malawian population showed enhanced accuracy but not enough to warrant clinical use. Despite an assumption of common physiological responses, disease and population differences seem to strongly determine the performance of EWS. Local validation and impact assessment of these scores should precede their adoption in resource limited settings.

This review critiques the benefits and drawbacks of the United Kingdom’s National Early Warning Score (NEWS). Potential developments for the future are considered, as well as the role for NEWS in an emergency department (ED). The ability of NEWS to predict death within 24 h has been well validated in multiple clinical settings. It provides a common language for the assessment of clinical severity and can be used to trigger clinical interventions. However, it should not be used as the only metric for risk stratification as its ability to predict mortality beyond 24 h is not reliable and greatly influenced by other factors. The main drawbacks of NEWS are that measuring it requires trained professionals, it is time consuming and prone to calculation error. NEWS is recommended for use in acute UK hospitals, where it is linked to an escalation policy that reflects postgraduate experience; patients with lower NEWS are first assessed by a junior clinician and those with higher scores by more senior staff. This policy was based on expert opinion that did not consider workload implications. Nevertheless, its implementation has been shown to improve the efficient recording of vital signs. How and who should respond to different NEWS levels is uncertain and may vary according to the clinical setting and resources available. In the ED, simple triage scores which are quicker and easier to use may be more appropriate determinants of acuity. However, any alternative to NEWS should be easier and cheaper to use and provide evidence of outcome improvement.

Background. Prognostication is an important component of medical decision-making. A patients’ general prognosis can be difficult to measure. The Simple Prognostic Score (SPS) was designed to include patients’ age, mobility, aggregated vital signs, and the treating physician’s decision to admit to aid prognostication. Study Aim. Our study aim is to validate the SPS, compare it with the Emergency Severity Index (ESI) regarding its prognostic performance, and test the interrater reliability of the subjective variable of the decision to admit. Methods. Over a period of 9 weeks all patients presenting to the ED were included, routinely interviewed, final disposition registered, and followed up for one year. The C-statistics of discrimination was used to compare SPS and ESI predictions of 7-day, 30-day, and 1-year mortality. Youden J Statistics and Odds ratio, using logistical regression, were calculated for the Simple Prognostic Score. In a subset, a chart review was performed by senior physicians for a secondary assessment of the decision to admit. Interrater reliability was calculated using percentages and Cohens Kappa. Results. Out of 5648 patients, 3272 (57.9%) had a low SPS (i.e., ≤ 1); none of these patients died within 7 days, 2 (0.1%) died within 30 days after presentation and 19 (0.6%) died within a year. The area under the curve for 1-year mortality of the Simple Prognostic Score was 0.848. Secondary analysis of the interrater agreement for the decision to admit was 92%. Conclusion. In a prospective study of unselected ED patients, the Simple Prognostic Score was validated as a reliable predictor of short- and long-term mortality.

Abnormalities of vital signs are quantified by comparison with normal ranges, which are those observed in resting healthy populations. It might be more appropriate to compare the vital sign values of an individual in distress with their own usual values recorded when they were stable and well. Sensors from smartwatches or smartphones might make this possible at scale, but the proportion of patients using them is not known. This study aimed to assess the feasibility of using heart rate and mobility data from patients' own wearable sensors as part of clinical assessments at the time of presentation to hospitals with medical emergencies, and to quantify the difference between heart rate and the change in daily steps taken by the patient on admission to acute care compared with the previously recorded values at home. This is an international, multicenter observational study using the flashmob research design. The study will recruit patients aged 18 years and older who present to emergency departments, acute medical departments, or ambulatory emergency care with an acute medical complaint. Main end points of the study include the proportion of patients assessed for an acute complaint who use wearable devices to record vital signs. The study will describe the population that uses devices that collect vital signs in terms of sex, age group, digital literacy, and the severity of illness on presentation (as measured by a standard set of vital signs and frailty). Trends in heart rate and step counts measured in the month before presentation to acute care services will be reported according to discharge or admission status. Data will be collected during a pilot phase and during a single week in centers across Europe. The study has been registered and passed the required approvals in the Netherlands Medical Ethics Committee (MEC-2022-0795) and the United Kingdom Integrated Research Application System (IRAS 321129). Based on the results of a pilot study performed at a single site in the United Kingdom, a flashmob study has been concluded in hospitals throughout Europe in May 2024 and reported in 2025. With the increasing availability of consumer held devices able to record medically relevant information this study will provide information about the availability of these data for clinical use in a number of European settings. DERR1-10.2196/55975.

Many patients experience a gradual decline in health before seeking hospital care, with subtle changes in vital signs such as increased heart rate or decreased mobility. Recognizing deviations from baseline vital signs can support clinical decision-making, especially admission decisions. Smart devices (ie, smartphones, smartwatches, and activity trackers) track health metrics like heart rate and step count, offering new opportunities to estimate illness severity and track deterioration early. This study aimed to assess the feasibility of using heart rate and step count measurements from smart devices (ie, smartphones, smartwatches, and activity trackers) to enhance the evaluation of patients presenting with acute illness in emergency settings. We conducted an international multicenter prospective observational study using the flash mob study design in 34 hospitals in the Netherlands (n=17), the United Kingdom (n=7), Denmark (n=9), and Switzerland (n=1) in May 2024. Researchers collaborated with patients to complete questionnaires upon an acute care (ie, emergency department, acute medical unit, same day emergency care) visit and extracted physiological data from their smart devices. Among patients with an acute care visit (n=1137), 40% (n=452) had a smart device with health data. These patients tended to be from a higher educational level and in relatively good health. Only half had retrievable heart rate or step count data, resulting in a usable data set for 20% (n=209) of the total study population. Analysis showed a significant increase in heart rate (P<.001) and a decrease in step count (P<.001) in the days preceding their hospital visit. Both heart rate (P=.04) and step count (P=.04) on the day before presentation were significantly associated with disposition. Our study demonstrates the feasibility of using a patient's personal smart device to monitor vital signs in the days leading up to an acute care visit. In a selected patient group, significant changes in heart rate and step count were observed prior to hospital presentation, suggesting that disposition may be predicted using data collected from the patient's own device. High-risk patient groups, who might benefit the most from digital health monitoring, are currently underrepresented among device users.

Background ‘Failure to rescue’ of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology. Methods A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use. Results Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. ‘Check In’), a list of prompts regarding common omissions (i.e. ‘Stop & Think’), and, a list of items required for the safe “handover” of patients that remain on the general ward (i.e. ‘Check Out’). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients. Conclusions Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are needed.

Introduction Oral curcumin decreases inflammatory cytokines and increases muscle regeneration in mice. Purpose To determine effects of curcumin on muscle damage, inflammation and delayed onset muscle soreness (DOMS) in humans. Method Seventeen men completed a double-blind randomized-controlled crossover trial to estimate the effects of oral curcumin supplementation (2.5 g twice daily) versus placebo on single-leg jump performance and DOMS following unaccustomed heavy eccentric exercise. Curcumin or placebo was taken 2 d before to 3 d after eccentric single-leg press exercise, separated by 14-d washout. Measurements were made at baseline, and 0, 24 and 48-h post-exercise comprising: (a) limb pain (1–10 cm visual analogue scale; VAS), (b) muscle swelling, (c) single-leg jump height, and (d) serum markers of muscle damage and inflammation. Standardized magnitude-based inference was used to define outcomes. Results At 24 and 48-h post-exercise, curcumin caused moderate-large reductions in pain during single-leg squat (VAS scale −1.4 to −1.7; 90 %CL: ±1.0), gluteal stretch (−1.0 to −1.9; ±0.9), squat jump (−1.5 to −1.1; ± 1.2) and small reductions in creatine kinase activity (−22–29 %; ±21–22 %). Associated with the pain reduction was a small increase in single-leg jump performance (15 %; 90 %CL ± 12 %). Curcumin increased interleukin-6 concentrations at 0-h (31 %; ±29 %) and 48-h (32 %; ±29 %) relative to baseline, but decreased IL-6 at 24-h relative to post-exercise (−20 %; ±18 %). Conclusions Oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance. Further study is required on mechanisms and translational effects on sport or vocational performance.

The association between QRS voltage and QTc interval prolongation with mortality for up to 1 year after recording an ECG on patients attending emergency departments (EDs) was examined in a retrospective register-based observational study on 37,473 patients attending 2 Danish EDs. Of 37,473 patients who had an ECG performed on their first ED presentation 2,164 (5.8%) died within 30 days of presentation and 6,395 (17.1%) died within a year. Compared with survivors, patients who died had significantly longer QRS intervals and lower QRS voltages. A combined lead I and II QRS voltage <=1.4 mV was consistently associated with approximately twice the risk of mortality for up to at least 1 year after the ECG recording and this risk was not influenced by the length of the QTc interval. The increased mortality risk of a low QRS voltage remained even after adjustment for age, gender, Charlson co-morbidity index, and abnormal sodium and urea levels. In conclusion, low QRS voltage is a simple measurement that could potentially be used as an objective prognostic marker.