scholarly journals Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes

Resuscitation ◽  
2015 ◽  
Vol 87 ◽  
pp. 75-80 ◽  
Author(s):  
Stuart Jarvis ◽  
Caroline Kovacs ◽  
Jim Briggs ◽  
Paul Meredith ◽  
Paul E. Schmidt ◽  
...  
Keyword(s):  
Early Warning ◽  
Vital Signs ◽  
Adverse Outcomes ◽  
Early Warning Score ◽  
News Values ◽  
National Early Warning Score

scholarly journals Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends

2017 ◽  
Vol 22 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Mohammed Mohammed ◽  
Muhammad Faisal ◽  
Donald Richardson ◽  
Robin Howes ◽  
Kevin Beatson ◽  
...  
Keyword(s):  
Early Warning ◽  
Odds Ratio ◽  
Vital Signs ◽  
Early Warning Score ◽  
Emergency Admissions ◽  
Clinical Assessments ◽  
Admission Time ◽  
Emergency Medical ◽  
Acute Hospitals ◽  
National Early Warning Score

Objective Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p < 0.001) with a higher mortality (weekend: 706/11,332 6.23% vs. weekday: 2039/35,785 5.70%; odds ratio = 1.10, 95% CI 1.01 to 1.20, p = 0.04) which was no longer seen after adjusting for the index National Early Warning Score (odds ratio = 0.99, 95% CI 0.90 to 1.09, p = 0.87). Index National Early Warning Score was recorded sooner (−0.45 h, 95% CI −0.52 to −0.38, p < 0.001) for weekend admissions. Conclusions Emergency medical admissions at the weekend with electronic National Early Warning Score recorded within 24 h are sicker, have earlier clinical assessments, and after adjusting for the severity of their sickness, do not appear to have a higher mortality compared to weekday admissions. A larger definitive study to confirm these findings is needed.

scholarly journals Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6947 ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Izumu Hasegawa ◽  
Masahiko Uzura ◽  
Kenji Okuno ◽  
Kei Otani ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Early Warning ◽  
Pressure Pulse ◽  
Vital Signs ◽  
Early Warning Score ◽  
Single Centre ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
National Early Warning Score

The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.

scholarly journals Do medical students recognise the deteriorating patient by analysing their vital signs? A monocentric observational study based on the National Early Warning Score 2

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044354
Author(s):  
David Alexander Christian Messerer ◽  
Michael Fauler ◽  
Astrid Horneffer ◽  
Achim Schneider ◽  
Oliver Keis ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Response ◽  
Early Warning ◽  
Vital Signs ◽  
Early Warning Score ◽  
Professional Activity ◽  
Monitoring Frequency ◽  
National Early Warning Score ◽  
Deteriorating Patient ◽  
Current Risk

ObjectiveAssessment of the expertise of medical students in evaluating vital signs and their implications for the current risk of a patient, an appropriate monitoring frequency, and a proper clinical response.Methods251 second-year and 267 fifth-year medical students in a curriculum consisting of 6 years of medical school at Ulm University, Germany, were interviewed in a paper-based questionnaire. The students were asked to rate their proficiency in interpreting vital signs and to give pathological thresholds of vital signs. Based on the National Early Warning Score 2 (NEWS2), nine vital signs of fictional patients were created and students were asked to comment on their clinical risk, to set an appropriate monitoring frequency as well as a clinical response.ResultsInterviewing medical students regarding each vital sign individually, the students indicated a pathological threshold in accordance with the NEWS2 for respiratory rate, temperature, and heart rate. By contrast, inappropriate pathological limits were given regarding oxygen saturation and systolic blood pressure. Translating the vital signs into nine fictional patients, fifth-year medical students overall chose an appropriate response in 78% (67%−78%, median±IQR). In detail, fifth-year students successfully identified patients at very high or low risk and allocated them accordingly. However, cases on the edge were often stratified inappropriately. For example, a fictional case with vital signs indicating a surging sepsis was frequently underappreciated (48.5%) and allocated to an insufficient clinical response by fifth-year students.ConclusionsRecognising the healthy as well as the deteriorating patient is a key ability for future physicians. NEWS2-based education might be a valuable tool to assess and give feedback on student’s knowledge in this vital professional activity.

scholarly journals Abbreviated National Early Warning Score predicts the need for hospital admission and in-hospital mortality in elderly patients

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Masahiko Hujita ◽  
Izumu Hasegawa ◽  
Kei Otani ◽  
Kenji Okuno ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Early Warning ◽  
Roc Analysis ◽  
Pressure Pulse ◽  
Vital Signs ◽  
Early Warning Score ◽  
Operating Characteristics ◽  
Peripheral Oxygen Saturation ◽  
National Early Warning Score

The aim of this study was to evaluate the value of the Abbreviated National Early Warning Score (aNEWS) for predicting admissions and in-hospital mortality in elderly patients present to Emergency Department (ED). This retrospective, single-centred observational study was carried out in the ED of Minamitama Hospital, in Tokyo, Japan from 1 April 2018 to 30 April 2018. All of the patients aged 65 and older were included in this study. The aNEWS is based on six common physiological vital signs, including peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate, and the Alert, responds to Voice, responds to Pain, Unresponsive score. The scores range from 0 and 3 for each parameter. The aNEWS ranged from a score of 0 to a maximum of 17. The receiver operating characteristics (ROC) analysis was used to evaluate the predictive value of the aNEWS for admission and in-hospital mortality. The median aNEWS of patients admitted to the hospital was significantly higher than that of patients discharged from the ED (P<0.001). The median aNEWS of survivors was significantly higher than that of non-survivors (P<0.001). The Areas under the ROC Curve (AUC) for predicting admission was 0.773 [95% CI 0.7142 to 0.8317, P<0.001] for the aNEWS. The AUC for predicting in-hospital mortality was 0.791 [95% CI 0.604 to 0.978, P<0.001] for the aNEWS. Our single-centred study has demonstrated the utility of the aNEWS as a predictor of patient admission and in-hospital mortality in elderly patients.

scholarly journals National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kai Zhang ◽  
Xing Zhang ◽  
Wenyun Ding ◽  
Nanxia Xuan ◽  
Baoping Tian ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Early Warning ◽  
Adverse Outcomes ◽  
Early Warning Score ◽  
Predictive Tool ◽  
Prognostic Accuracy ◽  
Prediction Of Mortality ◽  
National Early Warning Score

Background: The prognostic value of the national early warning score (NEWS) in patients with infections remains controversial. We aimed to evaluate the prognostic accuracy of NEWS for prediction of in-hospital mortality in patients with infections outside the intensive care unit (ICU).Methods: We searched PubMed, Embase, and Scopus for related articles from January 2012 to April 2021. Sensitivity, specificity, and likelihood ratios were pooled by using the bivariate random-effects model. Overall prognostic performance was summarized by using the area under the curve (AUC). We performed subgroup analyses to assess the prognostic accuracy of NEWS in selected populations.Results: A total of 21 studies with 107,008 participants were included. The pooled sensitivity and specificity of NEWS were 0.71 and 0.60. The pooled AUC of NEWS was 0.70, which was similar to quick sequential organ failure assessment (qSOFA, AUC: 0.70) and better than systemic inflammatory response syndrome (SIRS, AUC: 0.60). However, the sensitivity (0.55) and AUC (0.63) of NEWS were poor in elder patients. The NEWS of 5 was more sensitive, which was a better threshold for activating urgent assessment and treatment.Conclusions: The NEWS had good diagnostic accuracy for early prediction of mortality in patients with infections outside the ICU, and the sensitivity and specificity were more moderate when compared with qSOFA and SIRS. Insufficient sensitivity and poor performance in the elder population may have limitations as an early warning score for adverse outcomes. NEWS should be used for continuous monitoring rather than a single time point predictive tool.

scholarly journals Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034602
Author(s):  
Takuro Endo ◽  
Toru Yoshida ◽  
Tomohiro Shinozaki ◽  
Takako Motohashi ◽  
Hsiang-Chin Hsu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Early Warning ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Early Warning Score ◽  
Patient Disposition ◽  
Hospitalised Patients ◽  
National Early Warning Score

ObjectivesThe National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.DesignThis retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.SettingA tertiary hospital in Japan.ParticipantsOverall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.ResultsThe mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 60.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 110.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively.ConclusionThe findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition.

scholarly journals ChroniSense National Early Warning Score Study (CHESS): a wearable wrist device to measure vital signs in hospitalised patients—protocol and study design

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028219
Author(s):  
Michelle Helena Van Velthoven ◽  
Felicia Adjei ◽  
Dimitris Vavoulis ◽  
Glenn Wells ◽  
David Brindley ◽  
...  
Keyword(s):  
Early Warning ◽  
Vital Sign ◽  
Clinical Decision Making ◽  
Vital Signs ◽  
Early Warning Score ◽  
Individual Parameter ◽  
Standard Clinical Practice ◽  
Reference Number ◽  
Hospitalised Patients ◽  
National Early Warning Score

IntroductionThe National Early Warning Score is used as standard clinical practice in the UK as a track and trigger system to monitor hospitalised patients. Currently, nurses are tasked to take routine vital signs measurements and manually record these on a clinical chart. Wearable devices could provide an easier, reliable, more convenient and cost-effective method of monitoring. Our aim is to evaluate the clinical validity of Polso (ChroniSense Medical, Yokneam Illit, Israel), a wrist-based device, to provide National Early Warning Scores.Methods and analysisWe will compare Polso National Early Warning Score measurements to the currently used manual measurements in a UK Teaching District General Hospital. Patients aged 18 years or above who require recordings of observations of vital signs at least every 6 hours will be enrolled after consenting. The sample size for the study was calculated to be 300 participants based on the assumption that the final dataset will include four pairs of measurements per-patient and per-vital sign, resulting in a total of 1200 pairs of data points per vital sign. The primary outcome is the agreement on the individual parameter scores and values of the National Early Warning Score: (1) respiratory rate, (2) oxygen saturation, (3) body temperature, (4) systolic blood pressure and (5) heart rate. Secondary outcomes are the agreement on the aggregate National Early Warning Score. The incidence of adverse events will be recorded. The measurements by the device will not be used for the clinical decision-making in this study.Ethics and disseminationWe obtained ethical approval, reference number 18/LO/0123 from London—Hampstead Research Ethics Committee, through the Integrated Research Application System, (reference number: 235 034. The study received no objection from the Medicine and Health Regulatory Authority, reference number: CI/20018/005 and has National Institute for Health Research portfolio adoption status CPMS number: 32 532.Trial registration numberNCT03448861; Pre-results.

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