Prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) among hospitalized patients assessed by a rapid response team

Abstract

Background Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and help determine subsequent management and disposition. We sought to evaluate and compare the prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of in-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected infection. Methods We retrospectively analyzed prospectively collected data (2012–2016) of consecutive RRT patients from two hospitals. The primary outcome was in-hospital mortality. We calculated the number needed to examine (NNE), which indicates the number of patients that need to be evaluated in order to detect one future death. Results Five thousand four hundred ninety-one patients were included, of whom 1837 (33.5%) died in-hospital. Mean age was 67.4 years, and 51.6% were male. A HEWS above the low-risk threshold (≥ 5) had a sensitivity of 75.9% (95% confidence interval (CI) 73.9–77.9) and specificity of 67.6% (95% CI 66.1–69.1) for mortality, with a NNE of 1.84. A NEWS2 above the low-risk threshold (≥ 5) had a sensitivity of 84.5% (95% CI 82.8–86.2), and specificity of 49.0% (95% CI: 47.4–50.7), with a NNE of 2.20. The area under the receiver operating characteristic curve (AUROC) was 0.76 (95% CI 0.75–0.77) for HEWS and 0.72 (95% CI: 0.71–0.74) for NEWS2. Among suspected infection patients ( n = 1708), AUROC for HEWS was 0.79 (95% CI 0.76–0.81) and for NEWS2, 0.75 (95% CI 0.73–0.78). Conclusions The HEWS has comparable clinical accuracy to NEWS2 for prediction of in-hospital mortality among RRT patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2355-3) contains supplementary material, which is available to authorized users.

Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

“…Perhaps it is not possible to reach higher AUC for sepsis recognition than NEWS2, using easy available vital signs and the biomarkers included in the statistical model. Other scores have not been able to demonstrate superiority over NEWS2 for prognostic accuracy for deterioration in infected patients [5,24].…”

Predictive powers of the Modified Early Warning Score and the National Early Warning Score in general ward patients who activated the medical emergency team

“…Thirdly, the study results may have limited generalizability because this study was conducted in a single center. Specifically, more than half of our patients (57.8%) had malignancies, which is a higher proportion than those of MET cohorts in previous studies [11,17]. To assess the outcome of the MET activation event itself rather than the outcome of underlying malignancy, we defined the primary outcome as 28-day mortality from MET activation.…”

“…the National Early Warning Score 2 (NEWS2) at MET activation [17], and showed that HEWS and NEWS2 both had comparably high accuracy (AUROC, 0.76 and 0.72, respectively). This result is different from the results of our current study, but the AUROC values in the two studies cannot be directly compared because the primary outcome (28-day mortality vs in-hospital mortality) and the EWS used (NEWS vs NEWS2) were different.…”

Predictive Value of 5 Early Warning Scores for Critical COVID-19 Patients

“…9,10 Five years later, the RCP updated NEWS to NEWS2, 11 which used the same parameters but altered their weights. HEWS, whose parameters are also the same as those of NEWS but with different weights, was developed in 2015, has successfully completed pilot-testing in the ED setting, [12][13][14] and is being used in some medical centers in Canada. MEWS was originally developed in 2000 to facilitate timely recognition of patients with established or impending critical illness.…”