A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

Abstract

Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. Methods:We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation.Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic.Results: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination.Conclusions: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO 2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

“…By means of logical, rank and consistency tests, the database was cleaned resulting in a total of 32 variables. Then a full analysis was carried out, variable-by-variable of unknown data, only considered for the analysis of vital signs, in line with previous studies [27,28]. The study variables do not present lost data.…”

“…The regular assessment of the risk of deterioration through EWS is a standard procedure in multiple clinical context the use of which is more than contrasted [14,15,28] and which can help to detect patients with TBI and a high risk [49,50]. Determining which patients may be subsidiaries of advanced procedures and rapid transportation to a useful center must be a priority for the EMS [51].…”

Impact of using data from electronic protocols in nursing performance management: A qualitative interview study

“…Indeed, some research has used different thresholds to differentiate patients with respiratory conditions (CREW: Lobo, Lynch, & Casserly, ), while others suggest developing different algorithms for groups with distinct physiological profiles (Downey et al, ). However, an increasing body of research has found EWS (particularly NEWS) may be suitable for diverse patient groups, including those with COPD (Hodgson, Congleton, Venn, Forni, & Roderick, ; Hydes et al, ; Kovacs et al, ; Pimentel et al, ; Redfern et al, ). Interviewees also disputed the necessity of the frequency of observations overall and whether there was always a need to take a whole set of observations, which reflects gaps in the evidence base (Smith et al, ).…”

The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals

“…Such a theory needs rigorous testing and without establishing the evidence base for adding confusion/delirium and that NEWS2 has increased sensitivity, specificity and positive predictive values than NEWS, we may be at risk of inadvertently undermining the efficiency of our escalation systems rather than improving them. 9,17 So, like other researchers, we also call for a more careful evaluation of NEWS2, with smaller scale testing, before widespread, financially incentivised, implementation. 11,17 It is, however, important to note that our findings should not detract from the importance and seriousness of confusion or delirium, especially in elderly hospitalised patients.…”

“…9,17 So, like other researchers, we also call for a more careful evaluation of NEWS2, with smaller scale testing, before widespread, financially incentivised, implementation. 11,17 It is, however, important to note that our findings should not detract from the importance and seriousness of confusion or delirium, especially in elderly hospitalised patients. 18,19 Nevertheless, with a relatively high prevalence of confusion or delirium amongst the hospital population, the proposed implementation of NEWS2 could swamp clinical staff with alerts that yield lower 'signal to noise' ratios than NEWS because a higher NEWS2 may no longer be as indicative of acute deterioration in physiological response to illness as NEWS.…”