Utility of a single early warning score in patients with sepsis in the emergency department

Abstract

An increased NEWS on arrival at ED is associated with higher odds of adverse outcome among patients with sepsis. The use of NEWS could facilitate patient pathways to ensure triage to a high acuity area of the ED and senior clinician involvement at an early stage.

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

“…We first assessed for association between the independent variables (NEWS, lactate, glucose and base excess) and the primary outcome measure using logistic regression analysis. We first used univariable (unadjusted) regression and then corrected the analysis for age and gender, using multivariable logistic regression analysis, to facilitate comparison with other research in this field [5,6]. To determine if the addition of age or gender influenced the strength of association with the primary outcome, we compared the results of the adjusted and unadjusted models.…”

“…This captured all patients with cardiac arrest at our institution, since all cardiac arrest survivors are admitted to the critical care unit. This outcome measure has been used previously in similar studies [4][5][6]16]. The secondary outcome measure was hospital length of stay.…”

“…A score of over 7 triggers a review by a critical care outreach team or medical response team. 5,6 Near patient testing on admission to hospital, for example arterial or venous blood gas sampling, is increasingly common and some blood gas variables are associated with clinical outcome [9]. In the literature there are established correlations between poor prognosis and elevations in serum lactate or acid base derangement in critically ill patients, as well as raised serum glucose following myocardial infarction.…”

“…EWS, like NEWS, have the potential to improve risk assessment in acutely unwell patients. NEWS is associated with admission to a critical care unit (level two or three care) and death in studies of patients with cancer, sepsis and medical diagnoses [4][5][6][7][8]. However, there is wider scope for using EWS as tools for prognostication in acutely unwell patients.…”

A proposed Primary Health Early Warning Score (PHEWS) with emphasis on early detection of sepsis in the elderly

“…7 Increasing age with associated decreasing immune responses contributes to worse outcomes in serious illness, including sepsis. 8,9 Weighting for the number of morbidities can be argued, but multiple major morbidities (diabetes, cardiovascular, respiratory, and renal impairment, etc) are associated with worse outcomes.…”