NEWS and qSIRS superior to qSOFA in the prediction of 30-day mortality in emergency department patients in Hong Kong

Abstract

Background: We aim to compare the prognostic value of Quick Sepsis-Related Organ Failure Assessment (qSOFA) and the previous Systemic Inflammatory Response Syndrome (SIRS) criteria, the National Early Warning Score (NEWS) and along with their combinations in the emergency department (ED). Methods: This single-centre prospective study recruited a convenience sample of unselected ED patients triaged as category 2 (Emergency) and 3 (Urgent). Receiver Operating Characteristic analyses were performed to determine the Area Under the Curve (AUC), along with sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for the various scores. Results: Of 1253 patients recruited, overall 30-day mortality was 5.7%. The prognostic value for prediction of 30-day mortality, with AUCs for qSOFA !2, SIRS !2, NEWS !5, qSIRS (qSOFA þ SIRS) !2 and NSIRS (NEWS þ SIRS) !5 of 0.56 (95%CI 0.53-0.58), 0.61 (95%CI 0.58-0.64), 0.61 (95%CI 0.58-0.64), 0.64 (95%CI 0.62-0.67) and 0.61 (95%CI 0.58-0.63), respectively. Using pairwise comparisons of ROC curves, NEWS !5 and qSIRS !2 were better than qSOFA !2 at predicting 30-day mortality. Conclusions: Among unselected emergency and urgent ED patients, the prognostic value for NEWS and qSIRS were greater than qSOFA, Combinations of qSOFA and SIRS could improve the predictive value for 30-day mortality for ED patients. KEY MESSAGES NEWS !5 and qSIRS !2 were better than qSOFA !2 at predicting 30-day mortality in ED patients. Combinations of qSOFA and SIRS could improve the predictive value for 30-day mortality for ED patients.

National Early Warning Score in Predicting Severe Adverse Outcomes of Emergency Medicine Patients: A Retrospective Cohort Study

“…[11][12][13][14][15][16] Some studies focused on the performance of NEWS in severity assessment and mortality prediction for category 2 (Emergency) and 3 (Urgent) patients. 17,18 These studies show that NEWS is a beneficial ED tool. However, since the patient cohorts of some of these studies were rather small, the predictive effect of NEWS may not have been accurate.…”

“…28 NEWS on ED arrival performs well in recognizing severity and prognosis of patients with severe sepsis and septic shock, patients with respiratory distress, elderly patients, and unselected emergency patients. 10,12,17,29 NEWS can serve as a useful tool for managing patients in a complex ED environment, enhancing patient care quality. 18 Compared with MEWS, qSOFA, and other warning scores, NEWS is generally more accurate in predicting admission and mortality for all patient types, showing that NEWS may have greater ED application value.…”

“…18 Compared with MEWS, qSOFA, and other warning scores, NEWS is generally more accurate in predicting admission and mortality for all patient types, showing that NEWS may have greater ED application value. 10,12,15,17,18,30 However, these studies contain several limitations. The patient cohorts of these studies were rather small, from several hundreds to thousands; 14,17,30,31 thus, the prediction effect for NEWS may not have been stable.…”

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

“…The characteristics of the studies are presented in Tables 1a and 1b. Of the 15 included studies, 8 were conducted in the ED (27)(28)(29)(30)(31)(32)(33)(34), and 7 in the prehospital setting (11,(35)(36)(37)(38)(39)(40). Nine studies were prospective cohort (28, 30-34, 36-38), ve were retrospective cohort (11,27,29,35,39), and one study followed a pragmatic clinical trial design (40).…”

“…Nine studies were prospective cohort (28, 30-34, 36-38), ve were retrospective cohort (11,27,29,35,39), and one study followed a pragmatic clinical trial design (40). In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34). In the pre-hospital setting, ve articles assessed NEWS2 (36-40) and three used NEWS (11,35,40).…”