Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission

Acute Medicine Journal ◽

10.52964/amja.0792 ◽

2020 ◽

Vol 19 (1) ◽

pp. 15-20

Author(s):

Immaculate Nakitende ◽

◽

Teopista Namujwiga ◽

Dustin Dunsmuir ◽

J. Mark Ansermino ◽

...

Keyword(s):

Observational Study ◽

Hospital Admission ◽

Early Warning ◽

Clinical Setting ◽

Computer Algorithm ◽

Early Warning Score ◽

Medical Patients ◽

National Early Warning Score ◽

Busy Clinical Setting ◽

Background Counting

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting. Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared. Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation. Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

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Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study

BMJ Open ◽

10.1136/bmjopen-2018-024636 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024636 ◽

Cited By ~ 3

Author(s):

Andreas Eckart ◽

Stephanie Isabelle Hauser ◽

Alexander Kutz ◽

Sebastian Haubitz ◽

Pierre Hausfater ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Risk Stratification ◽

Early Warning ◽

Inflammatory Markers ◽

Early Warning Score ◽

Receiver Operating Curve ◽

Secondary Outcome ◽

Icu Admission ◽

National Early Warning Score

ObjectivesThe National Early Warning Score (NEWS) helps to estimate mortality risk in emergency department (ED) patients. This study aimed to investigate whether the prognostic value of the NEWS at ED admission could be further improved by adding inflammatory blood markers (ie, white cell count (WCC), procalcitonin (PCT) and midregional-proadrenomedullin (MR-proADM).DesignSecondary analysis of a multinational, observational study (TRIAGE study, March 2013–October 2014).SettingThree tertiary care centres in France, Switzerland and the USA.ParticipantsA total of 1303 adult medical patients with complete NEWS data seeking ED care were included in the final analysis. NEWS was calculated retrospectively based on admission data.Main outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcome was intensive care unit (ICU) admission. We used multivariate regression analyses to investigate associations of NEWS and blood markers with outcomes and area under the receiver operating curve (AUC) as a measure of discrimination.ResultsOf the 1303 included patients, 54 (4.1%) died within 30 days. The NEWS alone showed fair prognostic accuracy for all-cause 30-day mortality (AUC 0.73), with a multivariate adjusted OR of 1.26 (95% CI 1.13 to 1.40, p<0.001). The AUCs for the prediction of mortality using the inflammatory markers WCC, PCT and MR-proADM were 0.64, 0.71 and 0.78, respectively. Combining NEWS with all three blood markers or only with MR-proADM clearly improved discrimination with an AUC of 0.82 (p=0.002). Combining the three inflammatory markers with NEWS improved prediction of ICU admission (AUC 0.70vs0.65 when using NEWS alone, p=0.006).ConclusionNEWS is helpful in risk stratification of ED patients and can be further improved by the addition of inflammatory blood markers. Future studies should investigate whether risk stratification by NEWS in addition to biomarkers improve site-of-care decision in this patient population.Trial registration numberNCT01768494; Post-results.

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Tracking the National Early Warning Score 2 from prehospital care to the emergency department: A prospective, ambulance-based, observational study

Prehospital Emergency Care ◽

10.1080/10903127.2021.2011995 ◽

2021 ◽

pp. 1-13

Author(s):

Francisco Martín-Rodríguez ◽

Ancor Sanz-García ◽

Guillermo J. Ortega ◽

Juan F. Delgado Benito ◽

Silvia Aparicio Obregon ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Early Warning ◽

Prehospital Care ◽

Early Warning Score ◽

National Early Warning Score

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THE ROLE OF NATIONAL EARLY WARNING SCORE (NEWS) IN MEDICAL EMERGENCY - PATIENTS IN INDIAN SCENARIO: A PROSPECTIVE OBSERVATIONAL STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2014/2315 ◽

2014 ◽

Vol 3 (13) ◽

pp. 3524-3528

Author(s):

Vanamali D R ◽

Sumalatha N ◽

Sriharsha Varma

Keyword(s):

Observational Study ◽

Early Warning ◽

Prospective Observational Study ◽

Early Warning Score ◽

Medical Emergency ◽

Emergency Patients ◽

National Early Warning Score ◽

Indian Scenario

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Copeptin combined with National Early Warning Score for predicting survival in elderly patients with acute and critical illness

10.21203/rs.3.rs-75438/v1 ◽

2020 ◽

Author(s):

Fan Wang ◽

Wen An ◽

Xinchao Zhang

Keyword(s):

Critical Illness ◽

Observational Study ◽

Elderly Patients ◽

Early Warning ◽

Predictive Value ◽

Early Warning Score ◽

Survival Prediction ◽

Vasopressin Release ◽

Risk Of Death ◽

National Early Warning Score

Abstract Purpose Copeptin, reflecting vasopressin release, as well as the National Early Warning Score (NEWS), reflecting the severity of critical illness, might qualify for survival prediction in elderly patients with acute and critical illness. This prospective observational study aimed at assessing the predictive value of copeptin combined with NEWS on the prognosis of elderly patients with acute and critical illness. Methods We analyzed serum copeptin levels and the NEWS at admission to the emergency department (ED) in a prospective, single-center and observational study comprising 205 elderly patients with acute and critical illness. Death within 30 days after admission to the ED was the primary end point. Results The serum copeptin levels and the NEWS in the non-survivor patients group were higher than those in the survivor group [30.35 (14.20, 38.91) vs 17.53 (13.01, 25.20), P = 0.001 and 9.0 (7.0–10.0) vs 7.0 (6.0–8.0), P = 0.001]. Multivariate logistic regression analysis showed that Copeptin, NEWS and copeptin combined with NEWS were all independent risk factors for 30-day mortality in elderly patients with acute and critical illness. Copeptin, NEWS and copeptin combined with NEWS all performed well in predicting 30-day survival, with area under the ROC curve (AUC) values of 0.766 (95%CI, 0.702–0.822), 0.797 (95%CI, 0.744–0.877) and 0.854 (95%CI, 0.798–0.899) respectively. Using the Z test to compare the areas under the above three curves, copeptin combined with NEWS showed a higher predictive value for 30-day survival (P < 0.05). As we calculated, the optimal cut-off value of copeptin and NEWS using the Youden index were 19.78 pg/ml and 8.5 points respectively. Risk stratification analysis showed that patients with both higher copeptin levels and higher NEWS had the highest risk of death. Conclusions Copeptin combined with NEWS have a stronger predictive power on the prognosis of elderly patients with acute and critical illness, comparing to either factor individually.

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