National early warning score (NEWS) in a Finnish multidisciplinary emergency department and direct vs. late admission to intensive care

Kivipuro, Mikko; Tirkkonen, Joonas; Kontula, Timo; Solin, J; Kalliomäki, Jari; Pauniaho, Satu‐Liisa; Yli‐Hankala, Arvi; Hoppu, Sanna

doi:10.1016/j.resuscitation.2018.05.020

Cited by 37 publications

(49 citation statements)

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“…We analyzed the data by NEWS2 and triage category testing differences in 30- day mortality, ED LOS, hospital and ICU/HDU admission. For the clarity of presentation of the results for ED LOS, the NEWS2 were grouped into low (0–4), moderate [ 5 , 6 ] and high (> = 7), in line with the Royal College of Physicians guideline [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…The evidence for early warning scores at the emergency department so far is limited: studies mostly include small or pre-selected sub-cohorts. One recent study showed that the national early warning score (NEWS2) is independently associated with mortality and ICU admissions [ 5 ]. Another study found that the modified early warning score (MEWS) adequately predicted hospitalization and in-hospital mortality for the older adults in the emergency department [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

et al. 2020

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Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED. Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥ 75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-h and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 h and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU. With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64–0.76) and 0.62 (0.56–0.68); for hospital admission prediction 0.62 (0.60–0.65) and 0.55 (0.52–0.56), and for HDU admission 0.72 (0.61–0.83) and 0.80 (0.70–0.90), respectively. The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p = 0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p < 0.001) but not between the yellow/green groups (p = 0.59). There were 48 and 351 revisits within 72 h and 30 days, respectively. With NEWS2 AUCs for 72-h and 30-day revisit prediction were 0.48 (95% CI 0.40–0.56) and 0.47 (0.44–0.51), respectively; with triage score 0.48 (0.40–0.56) and 0.49 (0.46–0.52), respectively. Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

et al. 2020

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“…The National Early Warning Score 1 (NEWS) and its modification, NEWS2 2 , are validated for the identification of patient deterioration in a range of clinical conditions and settings. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Both scores are advocated as screening tools for sepsis, 2 , 11 , 12 , 13 performing better than the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score 14 , 15 , 16 , 17 -a bedside prompt for identifying patients with suspected infection and a high risk of poor outcomes. 18 However, since the introduction of NEWS and NEWS2 in 2012 and 2017, respectively, the world has experienced an ongoing pandemic of a new infectious disease, coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).…”

Section: Introductionmentioning

confidence: 99%

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Chauhan

Meredith

Mortlock³

et al. 2021

Resuscitation

114

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Introduction Since the introduction of the UK’s National Early Warning Score (NEWS) and its modification, NEWS2, Coronavirus disease 2019 (COVID-19), has caused a worldwide pandemic. NEWS and NEWS2 have good predictive abilities in patients with other infections and sepsis, however there is little evidence of their performance in COVID-19. Methods Using receiver-operating characteristics analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS or NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24 h of a vital sign set in five cohorts (COVID-19 POSITIVE, n = 405; COVID-19 NOT DETECTED, n = 1716; COVID-19 NOT TESTED, n = 2686; CONTROL 2018, n = 6273; CONTROL 2019, n = 6523). Results The AUROC values for NEWS or NEWS2 for the combined outcome were: COVID-19 POSITIVE, 0.882 (0.868−0.895); COVID-19 NOT DETECTED, 0.875 (0.861−0.89); COVID-19 NOT TESTED, 0.876 (0.85−0.902); CONTROL 2018, 0.894 (0.884−0.904); CONTROL 2019, 0.842 (0.829−0.855). Conclusions The finding that NEWS or NEWS2 performance was good and similar in all five cohorts (range = 0.842−0.894) suggests that amendments to NEWS or NEWS2, such as the addition of new covariates or the need to change the weighting of existing parameters, are unnecessary when evaluating patients with COVID-19. Our results support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.

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“…Moreover, the NEWS is associated with mortality and intensive care unit admission in patients admitted to the ED. [9][10][11][12] As mentioned above, the NEWS is based on the patient's vital signs. However, in elderly patients, mortality prediction based on vital signs may be difficult because older patients may show subtle changes in vital signs due to a reduced physiological response to physiological stress.…”

Section: Introductionmentioning

confidence: 99%

Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department

et al. 2020

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Objective The National Early Warning Score (NEWS), based on the patients' vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED). Methods We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged > 65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality. Results In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3-8] vs. 1 [IQR, 0-3], P < 0.001). Multivariate logistic analysis showed that the NEWS was associated with in-hospital mortality, after adjusting for other confounders. The area under the curve of the NEWS for predicting in-hospital mortality was 0.820 (95% confidence interval, 0.806 to 0.833). Conclusion Our results show that the NEWS at admission is associated with in-hospital mortality among patients aged > 65 years.

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National early warning score (NEWS) in a Finnish multidisciplinary emergency department and direct vs. late admission to intensive care

Abstract: ED-NEWS is independently associated with in-hospital and 30-day mortality with acceptable discrimination capability. Direct and late ICU admissions occurred with comparable NEWSs at admission.

Cited by 37 publications

References 18 publications

National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department

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