National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study

Keep, J. M.; Messmer, Anna S.; Sladden, R. A.; Burrell, N; Pinate, R; Tunnicliff, Malcolm; Glucksman, E

doi:10.1136/emermed-2014-204465

Cited by 97 publications

(89 citation statements)

References 22 publications

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“…The NEWS is a rapid, highly convenient and non‐invasive scoring tool, and it is widely used in emergency departments, hospital admission and critical care . In particular, an elevated NEWS in emergency departments could be a trigger to screen the patient for severe sepsis and septic shock .…”

Section: Discussionmentioning

confidence: 99%

“…Among the early alarm tools, the National Early Warning Score (NEWS) is used to identify patients with increased risk of sepsis, cardiac arrest, unanticipated ICU admission and death on hospital admission or emergency department visitation . However, whether the NEWS at ICU discharge has value in predicting post‐ICU events, including PIRF in older patients with ICUmv‐lib, remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Post‐intensive care unit respiratory failure in older patients liberated from intensive care unit and ventilator: The predictive value of the National Early Warning Score on intensive care unit discharge

Chen

et al. 2019

Geriatrics Gerontology Int

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Aim The older adult population is continuously growing worldwide and there is increasing use of medical recourse in older patients, especially for those requiring intensive care unit (ICU) care and mechanical ventilation (MV). The present study aimed to investigate the burden and predictors of post‐ICU respiratory failure in older ICU patients weaned from MV. Methods In the present retrospective study, older ICU patients aged ≥60 years, who were successfully weaned from MV and discharged to the general ward from the ICU of Taipei Veterans General Hospital, Taipei, Taiwan, in 2011, were included. Biomarkers on ICU discharge, as well as the National Early Warning Score (NEWS) were recorded and calculated. The outcome measure was post‐ICU respiratory failure before day 14 (PIRF‐14) requiring reinstitution of MV. Logistical regression was used to assess the predictors for PIRF‐14. Results Of 272 patients included, 23 (8.5%) developed PIRF‐14. The post‐ICU in‐hospital mortality rates were 47.8% and 6.8% in patients with and without PIRF‐14 (adjusted OR 12.597, 95% CI 4.368–36.331). In a multivariate analysis, the levels of NEWS and hemoglobin on ICU discharge were independent predictors for PIRF‐14 (adjusted OR 1.273, 95% CI 1.076–1.507 and 0.645, 95% CI 0.474–0.879). In particular, patients with a NEWS of ≥10 and subsequent PIRF‐14 had a 15‐fold increased risk of mortality as compared with those without both factors (adjusted OR 15.418, 95% CI 4.344–54.720). Conclusions PIRF‐14 is associated with high mortality in older ICU patients, and NEWS is a significant predictor for PIRF‐14, which could be used to early identify patients at risk of post‐ICU respiratory failure in the specific population. Geriatr Gerontol Int 2019; 19: 317–322.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Post‐intensive care unit respiratory failure in older patients liberated from intensive care unit and ventilator: The predictive value of the National Early Warning Score on intensive care unit discharge

Chen

et al. 2019

Geriatrics Gerontology Int

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“…Keep et al 17 showed that a NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for severe sepsis, which may ultimately lead to early recognition and treatment. A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for severe sepsis at ED triage.…”

Section: Discussionmentioning

confidence: 99%

Validity of the Manchester Triage System in patients with sepsis presenting at the ED: a first assessment

et al. 2016

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BackgroundThe Manchester Triage System (MTS) does not have a specific presentational flow chart for sepsis. The goal of this investigation was to determine adequacy of acuity assignment for patients with sepsis presenting at the ED and triaged using the MTS. Materials and methods This retrospective analysis included patients >16 presenting to an ED in Bonn, Germany, on the first 12 days of each month between June 2012 and March 2014. Patients were classified into one of three septic groups, or no sepsis. For those with sepsis, adequacy of acuity assignment was based on the criteria of the first consensus conference of the American College of Chest Physicians and Society of Critical Care Medicine, first published in 1992. Adequacy of prioritisation is expressed as sensitivity and likelihood ratio (LR-). Results Among 20 836 patients evaluated, 801 (3.8%) were septic; of these, 581 (72.5%) had sepsis, 194 (24.2%) had severe sepsis and 26 (3.2%) had severe sepsis with circulation dysfunction. Patients who met the criteria for sepsis were correctly prioritised with a sensitivity of 70.4% (95% CI 66.5 to 74.0). The LR-was 0.628 (95% CI 0.564 to 0.698). Patients with severe sepsis were appropriately prioritised with a sensitivity of 84.5% (95% CI 78.1 to 89.4), and LR-was 0.330 (95% CI 0.243 to 0.450). In the group with severe sepsis and circulation dysfunction, sensitivity of MTS was 61.5% (95% CI 39.3 to 79.8), and LR-was 0.466 (95% CI 0.286 to 0.757). Conclusions The MTS has some weaknesses regarding priority levels in emergency patients with septic illness. Overall, target key symptoms (discriminators) which aim at identifying systemic infection and ascertaining vital parameters are insufficiently considered.

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“…The index test (i.e., potential diagnostic biomarkers) included, among others, presepsin (sCD14-ST) (24), PCT, Neutrophil CD64 (25), sTREM-1 (26), lipopolysaccharidebinding protein, pro-adrenomedullin, pro-vasopressin and a variety of inflammatory cytokines (27)(28)(29). Furthermore, the efficacy of many scoring systems and screening tools for detecting early sepsis has been evaluated (30,31). These include BioScore system (32), computer-weighted bedside scoring system (33), three-step sepsis screening tool (34), and spot check tissue oxygen saturation (StO 2 ) (35).…”

Section: Early Identification Of Sepsismentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study

Abstract: A NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment.

Cited by 97 publications

References 22 publications

Post‐intensive care unit respiratory failure in older patients liberated from intensive care unit and ventilator: The predictive value of the National Early Warning Score on intensive care unit discharge

Post‐intensive care unit respiratory failure in older patients liberated from intensive care unit and ventilator: The predictive value of the National Early Warning Score on intensive care unit discharge

Validity of the Manchester Triage System in patients with sepsis presenting at the ED: a first assessment

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

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