Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration?

Abstract

Our findings suggest that the NEWS could successfully be used by ambulance services to identify patients most at risk from subsequent deterioration. The implementation of this early warning system has the potential to support ambulance clinician decision making, providing an additional tool to identify and appropriately escalate care for acutely unwell patients.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…Also, by including only patients evaluated and evacuated in ALS, a high number of older adults were involved. This fact nonetheless reflects the target population of our geographic area, and it is in line with similar studies [9]. On the other hand, because data extraction was done on a nonblinded procedure, the cases were only considered if the mortality occurred-due to any cause-within the hospital and within the first 48 h after EMS care, in order to minimize the selection bias.…”

“…Our study shows that by incorporating a subsequent assessment of the pLA, a better characterization of the risk of mortality in patients with low risk is achieved. In this way, care professionals may know in advance the severity of the condition they are confronting and the actual need for evacuation, which certainly may facilitate the decision-making process [9,37].…”

“…The use of early warning scores (EWS) is a reality in the current clinical practice [3] and has become a standard procedure in many contexts and pathologies [4,5]. Among all scores, the National Early Warning Score 2 (NEWS2) [6] has proven to be useful in the prehospital context, is validated, and commonly used internationally [7][8][9]. Moreover, technological development has led to the use of rapid-response point-of-care testing [10,11], as such is the case of prehospital lactate (pLA), which is a sensitive indicator of tissue hypoperfusion, reliable, and easy to obtain [12,13].…”

Prehospital National Early Warning Score predicts early mortality

“…It is important that emergency medical services (EMS) are able to identify and track critically ill, high‐risk patients. Previous studies have demonstrated very encouraging results in the prehospital performance of NEWS in predicting mortality and likelihood of ICU admission and it has been suggested to be included in prehospital systems . A recent review noted a low number of studies assessing the use of early warning scores in a prehospital setting and their results were inconclusive and thus a further study was deemed justifiable.…”

Investigating ward nurses’ responses to deteriorating patients

“…In the UK, 98% of hospitals use track and trigger systems (National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2012). The use of NEWS is supported by evidence of its sensitivity in accurately predicting deterioration in patients who are acutely ill (Smith et al 2013, Bilben et al 2016, Shaw et al 2017. Despite this welldefined and widely used system, there is evidence that nurses do not consistently follow guidelines and trigger appropriate responses when presented with deteriorating patients (Donaldson et al 2014).…”