Recognition of deteriorating and critically ill patients in the acute care chain

In the acute care chain, a very heterogeneous group of patients receive acute medical treatment. While most of the patients suffer from injuries or medical conditions of low to moderate severity, a minority of patients suffer from life-threatening conditions needing urgent specialized treatment and interventions to prevent serious adverse events and death. Early identification of deteriorating or critically ill patients may lead to timely life-saving interventions.
While Early Warning Score (EWS) systems were originally developed to recognize the deteriorating patient admitted at the ward, their use in the acute care chain has increased over the past years. Retrospective cohort studies confirm that these models can indeed adequately predict in-hospital mortality and the need for intensive care unit admission in these patients. This is an interesting development, as EWS may help to identify patients who are likely to become critically ill, allowing for earlier treatment. However, despite these findings and considerations, the extent to which EWS are superior to standard care is unknown.
Therefore, this thesis examined and compared the performance of healthcare providers and risk stratification tools in identifying critically ill patients in the acute care chain.