The National Early Warning Score and its subcomponents recorded within ±24 h of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

Abstract

Hospital-acquired acute kidney injury (H-AKI) is a common cause of avoidable morbidity and mortality. Therefore , in the current study, we investigated whether vital signs data from patients, as defi ned by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. We analysed all emergency admissions (n=33,608) to York Hospital with NEWS data over a 24-month period. Here, we report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3), and similarly for maximum NEWS (models B0,B1,B2,B3). Of the total emergency admissions, 4.05% (1,361/33,608) had H-AKI. Models using the index NEWS had lower AUCs (0.59-0.68) than models using the maximum NEWS AUCs (0.75-0.77). The maximum NEWS model (B3) was more sensitive than the index NEWS model (A0) (67.60% vs 19.84%) but identifi ed twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Based on these results, we suggest that the index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but appears to be unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload, albeit with improved sensitivity.

The United Kingdom’s National Early Warning Score: should everyone use it? A narrative review

“…Since NEWS does not consider urine output, it may miss acute kidney injury [ 53 ], and by not including diastolic blood pressure might miss early distributive shock. It may not detect stroke or raised intracranial pressure (i.e., Cushing’s triad of an irregular breathing pattern, bradycardia, and hypertension).…”

Delivering a dignified death in a challenged national health system

“…4 I hope we achieve, in some small measure, a positive focus on this important aspect of our professional care. It is apt that this edition combines CME in acute medicine, a specific look at the strengths and limitations of the NEWS score in acute injury 5 (which is particularly timely as the revised NEWS has just been released) 6 and a focus on many issues that affect the elderly. I hope this combination offers practical and helpful education and thought-provoking articles across the whole spectrum of care we deliver, both in the acute life-saving domain and at the end of life.…”

Acute Kidney Injury: The Hidden Killer in the Ward

“…A study by Faisal et al (2018) highlights that National Early Warning Scores (NEWS2) (used to identify deterioration in patients) does not reflect illness severity in patients with AKI. Patients with stage‐3 AKI have multiple complications including elevated potassium, acidosis and fluid overload and these complications are associated with increased risk of death (Libório et al 2015).…”