The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals

Abstract

Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised ABSTRACT emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

Cross-cultural adaptation and validation of the Hamilton Early Warning Score for Brazil

“…The HEWS is shown to be a differentiated scale because it includes a variation in the score according to the volume of oxygen offered, indicating the patient who is in greater respiratory instability (24) . Another differential was to consider the presence of mental confusion or delirium, since patients with acute illness may manifest changes in mental status as a result of hypoxia, hypotension, sepsis or metabolic disorders (10,27) .…”

“…It is worth noting that the complexity of comorbidities and drug use interfere with the patient's physiological response, thus, this interference may imply the reliability of the HEWS -Brazilian version. In view of the exposed, the nursing team needs to associate their knowledge and experiences with these tools in order to identify values that reflect normality, or not, according to the patient's individuality (5,27) .…”

Adaptação transcultural e validação da Hamilton Early Warning Score para o Brasil

“…A HEWS se mostra uma escala diferenciada por incluir uma variação na pontuação de acordo com o volume de oxigênio ofertado, apontando o paciente que se encontra em maior instabilidade do quadro respiratório (24) . Outro diferencial foi considerar a presença de confusão mental ou delirium, já que pacientes com doença aguda podem manifestar alteração no estado mental em decorrência de hipóxia, hipotensão, sepse ou distúrbios metabólicos (10,27) .…”

Empregabilidade do alerta nacional precoce 2 em doentes com Coronavírus / Employability of national early warning score 2 in patients with Coronavirus

“…O escore ≥ 7 significa haver a necessidade de uma avaliação de emergência por uma equipe clínica ou de atendimento intensivo, o que geralmente se faz com a transferência Brazilian Journal of Development, Curitiba, v.7, n.11, p. 106209-106231 nov. 2021 do paciente para uma área de atendimento de maior complexidade (MOHAMMED, 2019).…”