Prehospital National Early Warning Score predicts early mortality

Abstract

Background: National Early Warning Score (NEWS) has been shown to be the best early warning score to predict in-hospital mortality but there is limited information on its predictive value in a prehospital setting. The aim of the current study was to investigate the diagnostic accuracy of NEWS in a prehospital setting using large population-based databases in terms of short-term mortality. Methods:We calculated the NEWS scores from retrospective prehospital electronic patient record data and analysed their possible relationship to mortality. We included all patient records for patients 18 years or older with sufficient prehospital data to calculate NEWS from 17 August 2008 to 18 December 2015 encountered by the emergency medical services (EMS) in the Hospital District of Helsinki and Uusimaa, Finland. The primary outcome measure was death within 1 day of EMS dispatch.Results: 35 800 patients were included. Their mean (SD) age was 65.8 (19.9) years.The median value of NEWS was 3 (IQR 1-6). The primary outcome of death within 1 day of EMS dispatch occurred in 378 (1.1%) cases. Area under receiver operating characteristic curve (AUROC) for primary outcome of death within 1 day was 0.840 (95% CI 0.823-0.858). AUROC for 1 day mortality in trauma subgroup was 0.901 (95% CI 0.859-0.942). Conclusion:Prehospital NEWS predicts mortality within 1 day of EMS dispatch with good diagnostic accuracy. | 677 PIRNESKOSKI Et al.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…The sample size calculation was performed using an area under the curve (AUC) of the expected receiver operating characteristic (ROC) of 90% with a confidence level of 99% and an accuracy of 1%, with 2543 subjects. We estimated a follow-up loss in 5%, so the estimated final sample size was 2677 subjects, for an early mortality rate of 4%, in line with similar studies [7,11,18].…”

“…The use of early warning scores (EWS) is a reality in the current clinical practice [3] and has become a standard procedure in many contexts and pathologies [4,5]. Among all scores, the National Early Warning Score 2 (NEWS2) [6] has proven to be useful in the prehospital context, is validated, and commonly used internationally [7][8][9]. Moreover, technological development has led to the use of rapid-response point-of-care testing [10,11], as such is the case of prehospital lactate (pLA), which is a sensitive indicator of tissue hypoperfusion, reliable, and easy to obtain [12,13].…”

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

“…Works analyzing the use of EWS in a prehospital setting are numerous [14,15,30,31] and more specifically concern the use of EWS in patients with trauma [32][33][34][35]. Studies that specifically analyse scores to predict the risk of deterioration in TBI are scarce.…”

“…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].…”

“…The use of EWS in patients with major trauma is well-documented in clinical practice [13][14][15]. Similarly, the Glasgow Coma Scale (GCS) is normally used to establish the severity of the TBI [16][17][18].…”