The effectiveness of a national early warning score as a triage tool for activating a rapid response system in an outpatient setting

Ehara, Jun; Hiraoka, Eiji; Hsu, Hui‐Ping; Yamada, Tōru; Homma, Yosuke; Fujitani, Shigeki

doi:10.1097/md.0000000000018475

Cited by 15 publications

(14 citation statements)

References 25 publications

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“…This generated a very homogeneous cohort since all the cases were assessed by the physician at the ALS and the purpose of selecting cases was to detect those cases with a risk of deterioration. Secondly, early mortality (within 48 hours) was determined as one of the result outcomes but we are aware that this time limitation in the inclusion of cases is partial and it may be very interesting to study mortality rates after seven or 30 days, or even in the longer term, but the objective of this study is to analyze the influence of the procedures carried out by the EMS at the scene or en route, such that mortality after two days does not seem to be an adequate solution and this is in line with similar publications [27,55,56].…”

Section: Limitationssupporting

confidence: 53%

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: Limitationssupporting

confidence: 53%

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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“… 8 , 9 A striking aspect is that in COVID-19, the NEWS cut-off was ≥4, lower than the scores of 5 or 7 which are normally used in sepsis. 5 , 10 This lower cut-off value could be explained by the fact that patients with COVID-19 do not usually present with hypotension—in our study, systolic blood pressure ≤110 mmHg was present in just 15% of patients—and only 7% had alteration of level of consciousness.…”

Section: Discussionmentioning

confidence: 57%

The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19

Lalueza

Lora‐Tamayo

Calle

et al. 2021

Revista Clínica Española (English Edition)

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This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO 2 /FiO 2 ratio ≤ 200 mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥ 4 was found to be the best cutoff point for predicting respiratory failure.

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“…The advantage of this type of score is the possibility of early detection of the risk of clinical deterioration, which has facilitated its use in multiple health systems, with a global implementation [ 16 , 17 , 18 ]. In addition, EWSs provide alert triggers that are adaptable to virtually any disease, making them highly versatile tools, capable of being used in different environments, physio-pathological situations, healthcare worker trainings or even latitudes [ 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

Martin-Rodríguez

Conty

Sanz-García

et al. 2021

JPM

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Early warning scores (EWSs) help prevent and recognize and thereby act as the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different EWSs (National Early Warning Score 2 (NEWS2), quick sequential organ failure assessment score (qSOFA), Modified Rapid Emergency Medicine Score (MREMS) and Rapid Acute Physiology Score (RAPS)) to predict mortality within the first 48 h in patients suspected to have Coronavirus disease 2019 (COVID-19). We conducted a retrospective observational study in patients over 18 years of age who were treated by the advanced life support units and transferred to the emergency departments between March and July of 2020. Each patient was followed for two days registering their final diagnosis and mortality data. A total of 663 patients were included in our study. Early mortality within the first 48 h affected 53 patients (8.3%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2 (NEWS2), with an area under the curve of 0.825 (95% CI: 0.75–0.89). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients presented an area under the curve (AUC) of 0.804 (95% CI: 0.71–0.89), and the negative ones with an AUC of 0.863 (95% CI: 0.76–0.95). Among the EWSs, NEWS2 presented the best predictive power, even when it was separately applied to patients who tested positive and negative for SARS-CoV-2.

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The effectiveness of a national early warning score as a triage tool for activating a rapid response system in an outpatient setting

Abstract: Patron: HRH The Princess Royal 7-9 Breams BuildingsTel +44 (0)207 404 1999 London Fax +44 (0)207 067 1267 EC4A 1DT

Cited by 15 publications

References 25 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

The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

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