The use of medical early warning scores in high-risk acute coronary syndrome patients in a district hospital setting.

Clinical deterioration is often preceded by a change in physiological parameters. Inappropriate action to these changes can lead to increased mortality. One way to identify the critically ill patient is through physiologically based early warning scores (EWS) [1,2]. Use of EWS scores is advocated by the Royal College of Physicians, the Intensive Care Society and the Department of Health. Several generic scoring systems are available, although specific cardiac scoring systems also exist. The TIMI risk score for patients with unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI), validated in several large patient cohorts, is broadly applicable, easily calculated and stratifies a patient's risk of future events [3].