Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study

Abstract

BackgroundNational Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay.MethodsPlanned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study. Data were collected from ambulance report forms, medical notes and electronic patient records. Pre-hospital NEWS was calculated retrospectively. The primary outcome was a composite of death or critical care unit escalation within 48 h of hospital admission. The secondary outcome was length of hospital stay.Results189 patients were included in the analysis. The median pre-hospital NEWS was 3 (IQR 1–5). 13 patients (6.9%) died or were escalated to the critical care unit within 48 h of hospital admission. Pre-hospital NEWS was associated with death or critical care unit escalation (OR, 1.25; 95% CI, 1.04–1.51; p = 0.02), but NEWS on admission to hospital was more strongly associated with this outcome (OR, 1.52; 95% CI, 1.18–1.97, p < 0.01). Neither was associated with hospital length of stay.ConclusionPre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

“…However, in previous studies adding blood glucose to a scoring system added modest or no benefit 12–17. None of these studies were performed in a prehospital setting.…”

“…Of the previous studies, one relied on AUROC12 and one on likelihood ratio 13. Most study analyses used logistic regression analysis 14–17. Only Timotéo et al and van Toorenburg et al also used reclassification 14 15.…”

“…Only Timotéo et al and van Toorenburg et al also used reclassification 14 15. Risk of mortality was used as an outcome measure in four studies 12 14 16 17. Abbott et al 17 studied adding blood glucose to NEWS.…”

Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

“…Within the EWSs, the National Early Warning Score 2 (NEWS2), is the most widely used internationally, is validated in the prehospital context, and has proven its usefulness in very diverse clinical contexts [11][12][13]. The NEWS2 is determined from simple clinical observations (respiration rate, oxygen saturation, supplemental oxygen, temperature, systolic blood pressure, heart rate, and level of consciousness).…”

Semantic model-driven development for IoT interoperability of emergency services

“…Thresholds used by the detection mechanism have been defined based on existing classifications to detect health risks, both regarding bradycardia and tachycardia 123 . In particular, the approach based on Early Warning Scores [291] should be considered. For example, Table 7.2 illustrates the rules underlying each vital sign scoring function and set thresholds for both arrhythmia types, i.e., below 50 bpm for bradycardia and above 99 bpm for tachycardia.…”