Comparison of the Performance of 24 Early Warning Scores with the Updated National Early Warning Score (NEWS2) for Predicting Unplanned Intensive Care Unit (ICU) Admission in Postoperative Brain Tumor Patients: A Retrospective Study at a Single Center

Abstract

Background There have been few studies to evaluate early warning score (EWS) systems, or track and trigger systems (TTS), to identify early clinical deterioration in patients following brain tumor surgery who are admitted to the Intensive Care Unit (ICU). The National Early Warning Score (NEWS2) is an established method used in the U.K. National Health Service to improve care for in-hospital patients. This retrospective study from a single center aimed to compare the performance of NEWS2 with 24 other types of EWS to evaluate unplanned ICU admissions within 72 h after brain tumor surgery. Material/Methods A total of 326 patients with brain tumors were included in the study. Patients who experienced unplanned ICU transfer after surgery (69 cases) were diagnostically matched with patients who did not require intensive care (257 controls). We collected the physiological variables to calculate the area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, Youden index values, cutoff values, positive predictive values, and negative predictive values. Results The NEWS2 identified postoperative brain tumor patients with AUROC (0.860, p=0.000). The Patient-At-Risk (PAR) score was higher than NEWS2 in terms of AUROC value (0.870, P =0.000), Youden index (0.589 vs 0.542). Conclusions The findings showed that although the NEWS 2 performed well when used to evaluate unplanned ICU admissions within 72 h of postoperative brain tumor patients, the PAR score was also an accurate EWS.

Improving escalation of deteriorating patients through cognitive task analysis: Understanding differences between work-as-prescribed and work-as-done

“…The use of warning scores to detect deterioration is an internationally adopted strategy ( Douw et al, 2016 ; Peng et al, 2021 ; Romero-Brufau et al, 2014 ) and NEWS2 is the most commonly utilised system in the world ( Royal College of Physicians, 2017 ). The use of NEWS/NEWS2 has demonstrated many benefits ( Welch et al, 2022 ).…”

Patient Characteristics and Clinical and Economic Outcomes Associated with Unplanned Medical and Surgical Intensive Care Unit Admissions: A Retrospective Analysis

“…Unplanned admissions to the intensive care unit (ICU) are common, but the frequency reported in the current body of literature is wide, ranging from approximately <1% to 20% in surgical patients and 9% to 40% in medical patients. [1][2][3][4] These events are associated with increased hospital and ICU lengths of stay, as well as mortality, particularly in cases where transfers occur from the hospital ward or are delayed. 5,6 Respiratory and cardiac events are common reasons for ICU admission.…”

Development and Validation of a Multivariable Prediction Model for Postoperative Intensive Care Unit Stay in a Broad Surgical Population

“…Accurate preoperative prediction of surgical patients requiring postoperative ICU care could prove useful in allocating this precious resource. We identified 26 studies over the past 20 years related to predicting postoperative ICU use. Most of the studies (77%) covered specific types of surgery and thus were not generalizable to broad surgical populations .…”

“…We identified 26 studies over the past 20 years related to predicting postoperative ICU use. Most of the studies (77%) covered specific types of surgery and thus were not generalizable to broad surgical populations . Six studies included broader surgical populations, but 3 studies had small sample sizes (100 to 6000 patients), and 1 study included both preoperative and intraoperative predictors, making it not useful for prediction in the preoperative period .…”