A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study.

Pimentel, M.A.F., Redfern, O.C., Gerry, S., Collins, G.S., Malycha, J., Prytherch, D., Schmidt, P.E., Smith, G. B. and Watkinson, P.J., 2018. A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study. Resuscitation. (In Press)

Full text available as:

[img]
Preview
PDF (OPEN ACCESS ARTICLE)
PIIS0300957218309456.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

1MB

DOI: 10.1016/j.resuscitation.2018.09.026

Abstract

AIMS: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. METHODS: We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation. Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic. RESULTS: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination. CONCLUSIONS: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

Item Type:Article
ISSN:0300-9572
Uncontrolled Keywords:COPD; Early warning score; Physiological monitoring; Vital signs
Group:Faculty of Health & Social Sciences
ID Code:31381
Deposited By: Unnamed user with email symplectic@symplectic
Deposited On:22 Oct 2018 15:34
Last Modified:22 Oct 2018 15:34

Downloads

Downloads per month over past year

More statistics for this item...
Repository Staff Only -