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Validating the Electronic Cardiac Arrest Risk Triage (eCART) Score for Risk Stratification of Surgical Inpatients in

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Area of Science:

  • Critical Care Medicine
  • Health Services Research
  • Patient Safety

Background:

  • Postoperative clinical deterioration increases patient morbidity, mortality, and healthcare costs.
  • Early warning scores (EWS) aim to detect deterioration and activate rapid response teams.
  • Limited data exist on EWS application in postoperative inpatient settings.

Purpose of the Study:

  • To assess the predictive accuracy of three EWS for severe adverse events in postoperative inpatients.
  • To compare the performance of Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and electronic cardiac arrest risk triage (eCART) in this population.

Main Methods:

  • A retrospective cohort study included 32,537 adult patients hospitalized post-surgery.
  • Compared the accuracy of MEWS, NEWS, and eCART in predicting severe adverse events (ICU transfer, cardiac arrest, or death).
  • Area under the receiver operating characteristic curve (AUC) was used to evaluate predictive accuracy.

Main Results:

  • 3.8% of patients experienced a severe adverse outcome post-procedure.
  • eCART showed the highest accuracy (AUC 0.79), followed by NEWS (AUC 0.76) and MEWS (AUC 0.75).
  • Maximum respiratory rate was the most predictive individual vital sign (AUC 0.67).

Conclusions:

  • Early warning scores effectively predict severe adverse events in postoperative patients.
  • The eCART score is significantly more accurate than NEWS and MEWS for this patient group.
  • Findings support the use of eCART for enhanced postoperative patient monitoring.