A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

BackgroundTo determine if prehospital blood glucose could be added to National Early Warning Score (NEWS) for improved identification of risk of short-term mortality.MethodsRetrospective observational study (2008–2015) of adult patients seen by emergency medical services in Helsinki metropolitan area for whom all variables for calculation of NEWS and a blood glucose value were available. Survival of 24 hours and 30 days were determined. The NEWS parameters and glucose were tested by multivariate logistic regression model. Based on ORs we formed NEWSgluc model with hypoglycaemia (≤3.0 mmol/L) 3, normoglycaemia 0 and hyperglycaemia (≥11.1 mmol/L) 1 points. The scores from NEWS and NEWSgluc were compared using discrimination (area under the curve), calibration (Hosmer-Lemeshow test), likelihood ratio tests and reclassification (continuous net reclassification index (cNRI)).ResultsData of 27 141 patients were included in the study. Multivariable regression model for NEWSgluc parameters revealed a strong association with glucose disturbances and 24-hour and 30-day mortality. Likelihood ratios (LRs) for mortality at 24 hours using a cut-off point of 15 were for NEWSgluc: LR+ 17.78 and LR− 0.96 and for NEWS: LR+ 13.50 and LR− 0.92. Results were similar at 30 days. Risks per score point estimation and calibration model showed glucose added benefit to NEWS at 24 hours and at 30 days. Although areas under the curve were similar, reclassification test (cNRI) showed overall improvement of classification of survivors and non-survivors at 24 days and 30 days with NEWSgluc.ConclusionsIncluding glucose in NEWS in the prehospital setting seems to improve identification of patients at risk of death.

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Clinical and scientific letters: The national early warning score gives misleading scores for oxygen saturation in patients at risk of hypercapnia

Clinical Medicine ◽

10.7861/clinmedicine.15-1-98a ◽

2015 ◽

Vol 15 (1) ◽

pp. 98.2-98 ◽

Cited By ~ 1

Author(s):

B Ronan O’Driscoll ◽

Kirstie Grant ◽

Darren Green ◽

Simon Edeghere ◽

Nawar Diar Bakerly ◽

...

Keyword(s):

At Risk ◽

Oxygen Saturation ◽

Early Warning ◽

Early Warning Score ◽

Patients At Risk ◽

National Early Warning Score

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The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death

Resuscitation ◽

10.1016/j.resuscitation.2012.12.016 ◽

2013 ◽

Vol 84 (4) ◽

pp. 465-470 ◽

Cited By ~ 359

Author(s):

Gary B. Smith ◽

David R. Prytherch ◽

Paul Meredith ◽

Paul E. Schmidt ◽

Peter I. Featherstone

Keyword(s):

Intensive Care Unit ◽

At Risk ◽

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Early Warning ◽

Early Warning Score ◽

Patients At Risk ◽

National Early Warning Score

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A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

Critical Care Medicine ◽

10.1097/ccm.0000000000002000 ◽

2016 ◽

Vol 44 (12) ◽

pp. 2171-2181 ◽

Cited By ~ 30

Author(s):

Gary B. Smith ◽

David R. Prytherch ◽

Stuart Jarvis ◽

Caroline Kovacs ◽

Paul Meredith ◽

...

Keyword(s):

At Risk ◽

Clinical Outcomes ◽

Early Warning ◽

Medical Emergency Team ◽

Early Warning Score ◽

Medical Emergency ◽

Emergency Team ◽

Patients At Risk ◽

National Early Warning Score

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Can the prehospital National Early Warning Score 2 identify patients at risk of in-hospital early mortality? A prospective, multicenter cohort study

Heart & Lung ◽

10.1016/j.hrtlng.2020.02.047 ◽

2020 ◽

Vol 49 (5) ◽

pp. 585-591 ◽

Cited By ~ 3

Author(s):

Francisco Martín-Rodríguez ◽

Raúl López-Izquierdo ◽

Carlos del Pozo Vegas ◽

Irene Sánchez-Soberón ◽

Juan F. Delgado-Benito ◽

...

Keyword(s):

At Risk ◽

Cohort Study ◽

Early Warning ◽

Early Mortality ◽

Early Warning Score ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Patients At Risk ◽

National Early Warning Score

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Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-043721 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043721

Author(s):

Donald Richardson ◽

Muhammad Faisal ◽

Massimo Fiori ◽

Kevin Beatson ◽

Mohammed Mohammed

Keyword(s):

Hospital Mortality ◽

Early Warning ◽

Absolute Risk ◽

Cross Sectional Study ◽

Early Warning Score ◽

Cross Sectional ◽

Risk Of Mortality ◽

Baseline Mortality ◽

Acute Hospitals ◽

National Early Warning Score

ObjectivesAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.DesignA retrospective cross-sectional study.SettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).ConclusionsThe index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.

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