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However, traditional thresholds used in routine monitoring do not effectively identify serious adverse events (SAEs). This study aimed to assess the prognostic ability of combinations of threshold severity and duration in continuous vital sign monitoring for SAEs in acute medical and surgical patients. Data on heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2) were collected from four prospective observational studies and two randomised controlled trials. The primary outcome was an SAE within 30 days. Traditional thresholds were based on the National Early Warning Score, and optimised thresholds were derived by identifying threshold values and durations with the highest area under the receiver operating characteristic curve (AUROC) for any SAE and specific SAE types. Of 1492 patients, 1077 were included in HR and RR analyses and 761 in SpO2 analyses; 30% experienced an SAE. For any SAE, traditional thresholds had AUROC values of 0.47\u20130.50 (95% CI 0.43\u20130.54). Optimised thresholds also showed limited ability (AUROC 0.51, 95% CI 0.44\u20130.56). In contrast, 18 thresholds for specific SAE types had AUROC &gt; 0.70; the highest AUROC was observed for HR &gt; 104 beats\/min for \u226536 min for upcoming respiratory SAEs (AUROC 0.82, 95% CI 0.74\u20130.90). Optimised thresholds showed low prognostic ability for any SAE but higher AUROC than traditional thresholds. Several thresholds demonstrated moderate prognostic ability for specific SAE groups and warrant validation.<\/jats:p>","DOI":"10.3390\/s26175399","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:04:32Z","timestamp":1787756672000},"page":"5399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of Traditional and Optimised Vital Sign Thresholds for Risk of Serious Adverse Events in Continuously Monitored Hospitalised Patients"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-5947","authenticated-orcid":false,"given":"Nikolaj","family":"Aagaard","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0981-0723","authenticated-orcid":false,"given":"Markus Harboe","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"},{"name":"Department of Neuroanesthesiology, The Neuroscience Centre, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2062-9570","authenticated-orcid":false,"given":"Jesper","family":"M\u00f8lgaard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Centre for Cancer and Organ Diseases, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3045-6909","authenticated-orcid":false,"given":"Katja Kj\u00e6r","family":"Gr\u00f8nb\u00e6k","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel","family":"Elvekj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7131-2461","authenticated-orcid":false,"given":"Eske K.","family":"Aasvang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Centre for Cancer and Organ Diseases, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4885-4609","authenticated-orcid":false,"given":"Christian S.","family":"Meyhoff","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","first-page":"255","article-title":"Unexpected Deaths and Referrals to Intensive Care of Patients on General Wards. 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