A quick modified early warning score for triaging medical patients at admission

Cei, Francesco; Fenu, Patrizia; Sole, Carmela; Mumoli, Nicola; Cei, Marco

doi:10.1097/mej.0000000000000844

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Although statistically appropriate, the results provided by multivariate logistic regression analysis, AUC and net benefit analyses can be challenging to interpret by clinicians, because the results are too abstract to directly apply in clinical practice. The benefit of presenting a sequential post-test mortality risk is that it provides the actual mortality risk per category, which is intuitive to interpret [ 16 ]. In the univariate and AUC analysis, we found that the performance on 30-day mortality of suPAR and procalcitonin are in line with other studies [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study

Tong‐Minh¹,

Endeman²,

Ramakers³

et al. 2023

European Journal of Emergency Medicine

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van Gorp d,e and Yuri van der Does a Background and importance Early identification of patients at risk of clinical deterioration may improve prognosis of infected patients in the emergency department (ED). Combining clinical scoring systems with biomarkers may result in a more accurate prediction of mortality than a clinical scoring system or biomarker alone.Objective The objective of this study is to investigate the performance of the combination of National Early Warning Score-2 (NEWS2) and quick Sequential Organ Failure Assessment (qSOFA) score with soluble urokinase plasminogen activator receptor (suPAR) and procalcitonin to predict 30-day mortality in patients with a suspected infection in the ED. Design, settings and participantsThis was a single-center prospective observational study, conducted in the Netherlands. Patients with suspected infection in the ED were included in this study and followed-up for 30 days. The primary outcome of this study was all cause 30-day mortality. The association between suPAR and procalcitonin with mortality was assessed in subgroups of patients with low and high qSOFA (<1 and ≥1) and low and high NEWS2 (<7 and ≥7). Main resultsBetween March 2019 and December 2020, 958 patients were included. A total of 43 (4.5%) patients died within 30 days after ED visit. A suPAR ≥ 6 ng/ ml was associated with an increased mortality risk: 5.5 vs. 0.9% (P < 0.01) in patients with qSOFA = 0 and 10.7 vs. 2.1% (P = 0.02) in patients with qSOFA ≥ 1. There was also an association between procalcitonin ≥0.25 ng/ml and mortality: 5.5 vs. 1.9% (P = 0.02) for qSOFA = 0 and 11.9 vs. 4.1% (P = 0.03) for qSOFA ≥ 1. Similar associations were found within patients with a NEWS < 7 (5.9 vs. 1.2% for suPAR and 7.0 vs. 1.7% for procalcitonin, P < 0.001). ConclusionIn this prospective cohort study, suPAR and procalcitonin were associated with increased mortality in patients with either a low or high qSOFA and patients with low NEWS2.

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Section: Discussionmentioning

confidence: 99%

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study

Tong‐Minh¹,

Endeman²,

Ramakers³

et al. 2023

European Journal of Emergency Medicine

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“…Broadly speaking, we considered two types of score: generic scores-systems (NEWS2, MREMS, or ViEWS) applicable across all acute illnesses [17][18][19][20], which included RAPS, derived from the Acute Physiology and Chronic Health Evaluation II and customized for use in ambulance services; specific scores for particular conditions [21], such as CART, used in cardiovascular pathology, TEWS for trauma and injuries pathologies, and qSOFA, employed for patients with presumed infection in order to identify misleading cases of sepsis [22].…”

Section: Main Findingsmentioning

confidence: 99%

Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study

Martin-Rodríguez

Gambara

Sanz-García

et al. 2023

European Journal of Emergency Medicine

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BackgroundThe long-term predictive validity of early warning scores (EWS) has not been fully elucidated yet.Objective The aim of the present study is to compare seven prehospital EWS to predict 1-year mortality.Methods A prospective, multicenter, ambulance-based study of adult patients with an acute illness involving six advanced life support units and 38 basic life support units, referring to five emergency departments in Spain. ResultsThe primary outcome was long-term mortality with a 1-year follow-up. The compared scores included: National Early Warning Score 2, VitalPAC early warning score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score, and Triage Early Warning Score. Discriminative power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare the scores. Additionally, a Cox regression and Kaplan-Meier method were used. Between 8 October 2019, and 31 July 2021, a total of 2674 patients were selected. The MREMS presented the highest AUC of 0.77 (95% confidence interval, 0.75-0.79), significantly higher than those of the other EWS. It also exhibited the best performance in the DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94-4.31) for MREMS between 9 and 18 points, and 11.71 (7.21-19.02) for MREMS > 18]. Conclusion Among seven tested EWS, the use of the MREMS presented better characteristics to predict 1-year mortality; however, all these scores present moderate performances.

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A quick modified early warning score for triaging medical patients at admission

Cited by 2 publications

References 14 publications

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study

Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study

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