Cross-cultural adaptation and validation of the Hamilton Early Warning Score for Brazil

Vilaça, Luana Vilela e; Bernardinelli, Fabiana Cristina Pires; Correa, Allana dos Reis; Ohl, Rosali Isabel Barduchi; Barichello, Elizabeth; Chavaglia, Suzel Regina Ribeiro

doi:10.1590/1983-1447.2022.20210329.en

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Revista Gaúcha de Enfermagem

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Sumário

Original Article - Knowledge translation and advances in health and nursing practices • Rev. Gaúcha Enferm. 43 (spe) • 2022 • https://doi.org/10.1590/1983-1447.2022.20210329.en copy

Cross-cultural adaptation and validation of the Hamilton Early Warning Score for Brazil

Adaptación transcultural y validación del Hamilton Early Warning Score para Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Cross-culturally adapt and validate, for Portuguese, the Hamilton Early Warning Score to detect clinical deterioration in emergency services.

Method

Methodological study comprising the stages of translation, synthesis, back translation, expert committee (n=13), pre-test, submission, and analysis of the measurement properties in a sample of 188 patients. The Canadian Acute Scale Triage was compared with the Hamilton Early Warning Score. The Weighted Kappa Coefficient, Intraclass and Pearson Correlation Coefficient, Binary Logistic Regression and the Area Under the Receiver Operating Characteristic Curve were used for data analysis.

Results

The Hamilton Early Warning Score showed excellent reliability, α=0.924 (p<0.001). The construct validity identified a strong and negative correlation r=-0.75 and the predictive one presented an odds ratio of 1.63, 95% CI (1.358-1.918) (p<0.001).

Conclusion

The Hamilton Early Warning Score in Portuguese is valid and reliable to recognize patients in a condition of clinical deterioration in emergency services.

Keywords
Validation study; Early warning; Clinical deterioration; Emergency medical services; Cross-cultural comparison; Patient safety

Hamilton Early Warning Scale
	3	2	1	0	1	2	3
Heart rate		<40	41-50	51-100	101-110	111-130	>130
Systolic blood pressure	<70	71-90		91-170		171-200	>200
Respiratory rate	<8	8-13		14-20		21-30	>30
Temperature	<35º	35.1º-36.4º	36.5º-38º	38.1º-39º	>39.1º
Oxygen saturation	<85		85-91	>92
Oxygen supply				Ambient air	≤5l/min or ≤50% per mask		>5l/min or >50% per mask
Neurological status		Positive CAM		Alert	Verbal	Pain	Unresponsive
Neurological status according to the Confusion Assessment Tool (CAM) scale and assessment of the patient's response to stimuli according to the AVPU mnemonic (patient alert, responds to verbal stimulus, responds to painful stimulus or unresponsive to stimulus).

Validity indicators	Hamilton Early Warning Scale cutoff points
Validity indicators	≥3 (intermediate risk)	≥6(high risk)	≥9(very high risk)
Sensitivity	96.4%	71.4%	46.4%
Specificity	60.0%	86.9%	96.9%
False positives	40.0%	13.1	03.1%
False negatives	03.6%	28.6	53.6%

Combined outcome	Overall Accuracy
Cardiopulmonary arrest, death and transfer to the Intensive Care Unit	0.89 (0.831 - 0.953, 95% CI; p<0.001)
Individual outcomes	Accuracy
Cardiopulmonary arrest	0.98 (0.970 - 1.0; 95% CI; p<0.001)
Death	0.98 (0.975 - 1.0; 95% CI; p<0.001)
Transfer to the Intensive Care Unit	0.76 (0.676 - 0.854; 95% CI; p<0.001)

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author
Suzel Regina Ribeiro Chavaglia E-mail: suzel.ribeiro@yahoo.com.br