End points for validating early warning scores in the context of rapid response systems: a Delphi consensus study

Area of Science:

• Critical Care Medicine
• Health Services Research

Background:

• Traditional end points for early warning scores (EWS) include death, cardiac arrest, and ICU admission.
• These established end points may limit studies as many identified patients are unsalvageable.
• Expert opinion was sought on alternative end points for validating EWS in identifying at-risk hospital patients.

Purpose of the Study:

• To determine current expert consensus on optimal end points for validating risk stratification tools.
• To identify end points for identifying patients at risk of imminent critical illness in hospital wards.

Main Methods:

• Delphi consensus methodology was employed.
• A panel of 17 experts, selected by objective criteria, participated.
• Anonymized suggestions were iteratively reviewed, rated, and commented on by the panel.

Main Results:

• A comprehensive list of 86 potential end points across 13 themes was generated.
• No single end point was universally agreed upon as ideal.
• Themes of cardiac arrest, death, and level of care received the highest ratings.

Conclusions:

• Death, cardiac arrest, and ICU admission remain the most feasible end points for EWS validation studies.
• Future research may incorporate additional end points as large-scale, multi-parameter datasets become more accessible.