Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Ahmed, Wail; Rouse, Alex; Griggs, Katharine E.; Collett, Johnny; Dawes, Helen

doi:10.1038/s41393-019-0330-0

Cited by 3 publications

(3 citation statements)

References 19 publications

(2 reference statements)

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“…Studies that specifically analyse scores to predict the risk of deterioration in TBI are scarce. The scales most studied are the Revised Trauma Score [36], the GCS [16,18] and different physiological and analytical parameters [37] or scores on spinal damage [38]. Najafi et al [39] analyzed the use of different scores to predict the risk of death within 24 hours, including the NEWS, offering our study (although with a mortality outcome within 48 hours) better AUROC, as well as better sensitivity and specificity.…”

Section: Comparison With Previous Studiesmentioning

confidence: 93%

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Martin-Rodríguez

López-Izquierdo

Mohedano-Moriano

et al. 2020

IJERPH

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Traumatic brain injuries are complex situations in which the emergency medical services must quickly determine the risk of deterioration using minimal diagnostic methods. The aim of this study is to analyze whether the use of early warning scores can help with decision-making in these dynamic situations by determining the patients who need the intensive care unit. A prospective, multicentric cohort study without intervention was carried out on traumatic brain injury patients aged over 18 given advanced life support and taken to the hospital. Our study included a total of 209 cases. The total number of intensive-care unit admissions was 50 cases (23.9%). Of the scores analyzed, the National Early Warning Score2 was the best result presented with an area under the curve of 0.888 (0.81–0.94; p < 0.001) and an odds ratio of 25.4 (95% confidence interval (CI):11.2–57.5). The use of early warning scores (and specifically National Early Warning Score2) can help the emergency medical services to differentiate traumatic brain injury patients with a high risk of deterioration. The emergency medical services should use the early warning scores routinely in all cases for the early detection of high-risk situations.

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Section: Comparison With Previous Studiesmentioning

confidence: 93%

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Martin-Rodríguez

López-Izquierdo

Mohedano-Moriano

et al. 2020

IJERPH

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“…Doing so would likely have led to multiple false positives using qSOFA due to the typically low resting blood pressure in the cervical SCI population. 17 Neither the etiology of sepsis nor the presence or absence of indwelling medical devices (e.g., urinary catheters, feeding tubes, and tracheostomy tubes) were recorded upon chart review. This limits analysis of whether certain types of infections or the presence of certain medical devices increase the likelihood that sepsis will be detected by this hospital monitoring system.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our study did not include the blood pressure at the time of SIRS screening. Doing so would likely have led to multiple false positives using qSOFA due to the typically low resting blood pressure in the cervical SCI population 17 . Neither the etiology of sepsis nor the presence or absence of indwelling medical devices (e.g., urinary catheters, feeding tubes, and tracheostomy tubes) were recorded upon chart review.…”

Section: Discussionmentioning

confidence: 99%

Positive predictive value of a sepsis‐screening protocol for patients with tetraplegia

Goldish

Bechtel

Jones

et al. 2023

PM&R

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ObjectiveTo determine the positive predictive value (PPV) of a sepsis‐screening protocol in patients with cervical spinal cord injury (SCI).Design/MethodRetrospective review of all patients with cervical SCI who screened positive for two or more systemic inflammatory response syndrome (SIRS) criteria while hospitalized in acute care or inpatient rehabilitation units over a 3.5‐year period. Sepsis was defined by the occurrence of (1) any culture order followed by an intravenous (IV) antibiotic within 72 hours or (2) an IV antimicrobial followed by a culture order within 24 hours.ResultsA total of 134 patients screened positive for two or more SIRS criteria. Of these, 36 patients (26.9%) were diagnosed with sepsis. Factors associated with a true‐positive SIRS screen on multivariable analysis included American Spinal Injury Association Impairment Scale (AIS) grade A‐C (vs. D; p < .001). The PPV of the screen was 38% in patients with AIS A‐C and 9% in patients with AIS D. Altered mental status (AMS) was strongly associated with a diagnosis of sepsis; 16 of 18 (88.9%) of those with AMS had sepsis (p < .001). Age, sex, and neurologic level of injury were not associated with true‐positive screening. For patients with new SCI, the first true‐positive screen occurred a median of 31 days post‐injury. The most common SIRS criteria combinations in patients with true‐positive screens were elevated heart rate and either abnormal white blood cell count (43% of true positives) or abnormal temperature (26% of true positives). Abnormally low body temperature (<36°C) contributed to false‐positive screening for 10 of 38 (26%) AIS D patients who screened positive.ConclusionSepsis screening using SIRS criteria in hospitalized patients with tetraplegia has a PPV of 26.9%; it is significantly higher in patients with AIS A‐C versus D injuries. AMS, when combined with a positive SIRS screening, is strongly associated with sepsis.

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Vital sign differences between septic patients with tetraplegia and paraplegia

Song

Sankary

Burns

2022

Spinal Cord Ser Cases

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Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Cited by 3 publications

References 19 publications

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Positive predictive value of a sepsis‐screening protocol for patients with tetraplegia

Vital sign differences between septic patients with tetraplegia and paraplegia

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