Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

Vihonen, Hanna; Lääperi, Mitja; Kuisma, Markku; Pirneskoski, Jussi; Nurmi, Jouni

doi:10.1136/emermed-2018-208309

Cited by 14 publications

(23 citation statements)

References 28 publications

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“…Of the 15 included studies, 8 were conducted in the ED (27)(28)(29)(30)(31)(32)(33)(34), and 7 in the prehospital setting (11,(35)(36)(37)(38)(39)(40). Nine studies were prospective cohort (28, 30-34, 36-38), ve were retrospective cohort (11,27,29,35,39), and one study followed a pragmatic clinical trial design (40). In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34).…”

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

“…In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34). In the pre-hospital setting, ve articles assessed NEWS2 (36-40) and three used NEWS (11,35,40). Overall, the meta-analysis included 7,556 and 71,658 patients from the ED and pre-hospital settings, respectively.…”

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

“…Other versions of the EWS scores employ advanced therapies, laboratory testing and patients' demographic information. (10,11). The usage of EWS scores constitutes a standardised practice across the UK in both pre-hospital and in-hospital settings (7), and in some parts of Australia, a few selected EWS scores are applied in the in-hospital setting (12).…”

Section: Introductionmentioning

confidence: 99%

“…Numerous systematic reviews and meta-analyses have identi ed the optimal performing EWS scores in in-hospital settings (e.g., wards or the ED) (3,(13)(14)(15)(16)(17), however, only a limited number of reviews have focused on pre-hospital settings (18,19). Available systematic reviews have demonstrated that EWS scores can potentially improve patient outcomes (11)(12)(13)(14)(15) but, since there are several EWS scores that are used across different settings, it is unknown which score should be used in the ED or pre-hospital setting to best predict clinical outcomes (20,21). Furthermore, it is not known which EWS scores, and which cut-off points best predict outcomes such as short-term and long-term mortality or ICU admission (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Guan

Lee

Begg

et al. 2021

Preprint

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Background: It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration when applied in the emergency department (ED) or pre-hospital setting. Methods: This systematic review and meta-analysis assessed the predictive abilities of five commonly used EWS scores: National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS) and Cardiac Arrest Risk Triage (CART). Outcomes of interest included admission to ICU, up-to-≥3-day and 30-day mortality. Pooled estimates were calculated using DerSimonian and Laird random-effects models, constructed by type of EWS score, cut-off points, outcomes, and study setting. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-regressions investigated between study heterogeneity. Funnel plots tested for publication bias. Results: A total of 11,565 articles was identified, of which 15 were included. Eight and seven articles conducted in the ED and pre-hospital settings, respectively. In the ED, MEWS and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (Confidence Interval (CI) 2.35–6.99) to 6.48 (95% CI 1.83–22.89), p = 0.757. The ability of MEWS (cut-off point ≥ 3) to predict ICU admission had a similar pooled DOR of 5.54 (95% CI 2.02–15.21). In the pre-hospital setting, EWS scores failed to predict 30-day mortality. Using high cut-off points of 5, 7, or 9, their predictability improved when assessing up-to-≥3-day mortality with DOR ranging from 11.60 (95%, CI 9.75–13.88) to 20.37 (95% CI 13.16–31.52).Publication bias was not detected. Participants’ age explained 92% of between-study variance. Conclusion: EWS scores’ predictability of clinical deterioration improves when applied on patient populations that are already in the ED or hospital. The high thresholds used and the scores’ failure to predict 30-day mortality make them less suited for use in the pre-hospital setting.

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Section: Characteristics Of Articles Includedmentioning

confidence: 99%

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Guan

Lee

Begg

et al. 2021

Preprint

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“…Blood glucose disturbance is a common phenomenon during critical illness, can be quickly detected in the prehospital setting, and recently was proved to improve the accuracy of the National Early Warning Score (NEWS) to enhance identification of patients at risk of death [9].…”

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confidence: 99%

Reply to Ferrés-Padró et al. Comment on “Lionte et al. Association of Multiple Glycemic Parameters at Hospital Admission with Mortality and Short-Term Outcomes in Acutely Poisoned Patients. Diagnostics 2021, 11, 361”

et al. 2021

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Prehospital Early Warning Scores to Predict Mortality in Patients Using Ambulances

Ward¹,

Søvsø

Mogensen³

et al. 2023

JAMA Netw Open

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ImportanceEarly warning scores (EWSs) are designed for in-hospital use but are widely used in the prehospital field, especially in select groups of patients potentially at high risk. To be useful for paramedics in daily prehospital clinical practice, evaluations are needed of the predictive value of EWSs based on first measured vital signs on scene in large cohorts covering unselected patients using ambulance services.ObjectiveTo validate EWSs’ ability to predict mortality and intensive care unit (ICU) stay in an unselected cohort of adult patients who used ambulances.Design, Setting, and ParticipantsThis prognostic study conducted a validation based on a cohort of adult patients (aged ≥18 years) who used ambulances in the North Denmark Region from July 1, 2016, to December 31, 2020. EWSs (National Early Warning Score 2 [NEWS2], modified NEWS score without temperature [mNEWS], Quick Sepsis Related Organ Failure Assessment [qSOFA], Rapid Emergency Triage and Treatment System [RETTS], and Danish Emergency Process Triage [DEPT]) were calculated using first vital signs measured by ambulance personnel. Data were analyzed from September 2022 through May 2023.Main Outcomes and MeasuresThe primary outcome was 30-day-mortality. Secondary outcomes were 1-day-mortality and ICU admission. Discrimination was assessed using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC).ResultsThere were 107 569 unique patients (52 650 females [48.9%]; median [IQR] age, 65 [45-77] years) from the entire cohort of 219 323 patients who used ambulance services, among whom 119 992 patients (54.7%) had called the Danish national emergency number. NEWS2, mNEWS, RETTS, and DEPT performed similarly concerning 30-day mortality (AUROC range, 0.67 [95% CI, 0.66-0.68] for DEPT to 0.68 [95% CI, 0.68-0.69] for mNEWS), while qSOFA had lower performance (AUROC, 0.59 [95% CI, 0.59-0.60]; P vs other scores &lt; .001). All EWSs had low AUPRCs, ranging from 0.09 (95% CI, 0.09-0.09) for qSOFA to 0.14 (95% CI, 0.13-0.14) for mNEWS.. Concerning 1-day mortality and ICU admission NEWS2, mNEWS, RETTS, and DEPT performed similarly, with AUROCs ranging from 0.72 (95% CI, 0.71-0.73) for RETTS to 0.75 (95% CI, 0.74-0.76) for DEPT in 1-day mortality and 0.66 (95% CI, 0.65-0.67) for RETTS to 0.68 (95% CI, 0.67-0.69) for mNEWS in ICU admission, and all EWSs had low AUPRCs. These ranged from 0.02 (95% CI, 0.02-0.03) for qSOFA to 0.04 (95% CI, 0.04-0.04) for DEPT in 1-day mortality and 0.03 (95% CI, 0.03-0.03) for qSOFA to 0.05 (95% CI, 0.04-0.05) for DEPT in ICU admission.Conclusions and RelevanceThis study found that EWSs in daily clinical use in emergency medical settings performed moderately in the prehospital field among unselected patients who used ambulances when assessed based on initial measurements of vital signs. These findings suggest the need of appropriate triage and early identification of patients at low and high risk with new and better EWSs also suitable for prehospital use.

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Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

Cited by 14 publications

References 28 publications

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Reply to Ferrés-Padró et al. Comment on “Lionte et al. Association of Multiple Glycemic Parameters at Hospital Admission with Mortality and Short-Term Outcomes in Acutely Poisoned Patients. Diagnostics 2021, 11, 361”

Prehospital Early Warning Scores to Predict Mortality in Patients Using Ambulances

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