Differences in acute response team call triggering with CREWS scoring: A retrospective analysis

Background: Patients with chronic respiratory disease can have low oxygen saturations and elevated modified early warning score (MEWS) even when they are stable. The Chronic Respiratory Early Warning Score (CREWS) 1 aims to address this. Aim: To retrospectively evaluate the use of CREWS against MEWS and analyse differences in patients scoring >4 (the MEWS threshold for Acute Response Team (ART) review) in terms of 7 and 30 day mortality. Method: MEWS data for a total of 1207 inpatients were collated. 209 had underlying chronic respiratory disease; 170 of these had completed MEWS data. Retrospective CREWS were then calculated. Results: Applying CREWS made no difference with regards to an ART call in 161/170 patients. CREWS may have been useful in 6/9 remaining patients. In 2, MEWS was 4 generating ART evaluation. In 4, the MEWS was >4 with no mortality; CREWS was 4 with mortality at 7 days, CREWS would have been Conclusion: Applying CREWS would not have made a difference in the majority of patients. It may have potentially beneficial effects in some 4% patients in terms of triggering appropriate ART review while preventing unnecessary review in others. References Eccles SR, Subbe C, Hancock D, Thomson N. Crews: improving specificity whilst maintaining sensitivity of the National Early Warning Score in patients with chronic hypoxaemia. Resuscitation . Jan 2014; 85(1): 109-111.