scholarly journals The Ability of Early Warning Scores to Predict in Hospital Mortality and ICU Admission for Patients with Covid 19 Pneumonia in the Emergency Department

2021 ◽  
Author(s):  
Yunus Arik ◽  
Hatice Topçu ◽  
Mustafa Altınay
Keyword(s):  
Emergency Department ◽  
Early Warning ◽  
Early Recognition ◽  
Demographic Data ◽  
Scoring Systems ◽  
Early Warning Score ◽  
Youden Index ◽  
Icu Admission ◽  
Admission Rates ◽  
Diagnostic Values

Introduction: Early recognition of critical patients in crowded environments such as emergency departments is required in Covid 19 pandemic and many early recognition scoring systems are used. In this study, we aimed to determine the prognostic values of these scoring systems. Material and method: This retrospective study was performed between March 2020 -May 2020 and 212 patient who have Covid 19 pneumonia were enrolled the study. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated at the time of admission to the emergency department. Demographic data, mortality, intensive care unit (ICU) admission rates and the prognostic values of the scores were calculated. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by using Youden Index. Results: 23 (10.8%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882(0.741-1.000) and 0.879(0.768-0.990) and >65 years old, 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. While < 65 years old; MEWS and qSOFA’s optimal cut-off values for mortality were ≥2 with %90.0 sensitivity %74.7 specificity and ≥1 with %90.0 sensitivity %74.7 specificity, for ≥ 65 years NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity. Conclusion: All these three scores have good predictive value for mortality and ICU admission, but NEWS is better than MEWS and qSOFA especially in ≥ 65 years old patient with Covid 19 pneumonia.

scholarly journals Using modified early warning score to predict need of lifesaving intervention in adult non-trauma patients in a tertiary state hospital

2018 ◽  
Vol 25 (3) ◽  
pp. 146-151 ◽  
Author(s):  
Leong Shian Peng ◽  
Azhana Hassan ◽  
Aida Bustam ◽  
Muhaimin Noor Azhar ◽  
Rashidi Ahmad
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Early Warning ◽  
Demographic Data ◽  
Vital Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Level Of Consciousness

Background: Modified early warning score has been validated in many uses in the emergency department. We propose that the modified early warning score performs well in predicting the need of lifesaving interventions in the emergency department, as a predictor of patients who are critically ill. Objective: The study aims to evaluate the use of modified early warning score in sorting out critically ill patients in the emergency department. Methods: The patients’ demographic data and first vital signs (blood pressure, heart rate, temperature, respiratory rate, and level of consciousness) were collected prospectively. Individual modified early warning score was calculated. The outcome was a patient received one or more lifesaving interventions toward the end of stay in emergency department. Multivariate logistic regression analysis was utilized to assess the association between modified early warning score and other potential predictors with outcome. Results: There are a total of 259 patients enrolled into the study. The optimal modified early warning score in predicting lifesaving intervention was ≥4 with a sensitivity of 95% and specificity of 81%. Modified early warning score ≥4 (odds ratio = 96.97, 95% confidence interval = 11.82–795.23, p < 0.001) was found to significantly increase the risk of receiving lifesaving intervention in the emergency department. Conclusion: Modified early warning score is found to be a good predictor for patients in need of lifesaving intervention in the emergency department.

scholarly journals Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiao-Han Yap ◽  
Chip-Jin Ng ◽  
Kuang-Hung Hsu ◽  
Cheng-Yu Chien ◽  
Zhong Ning Leonard Goh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Warning ◽  
Emergency Departments ◽  
Scoring Systems ◽  
Early Warning Score ◽  
Categorical Variables ◽  
Emphysematous Pyelonephritis ◽  
Icu Admission ◽  
Training And Research

Abstract This study assesses the performance of National Early Warning Score (NEWS), Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting emphysematous pyelonephritis (EPN) patients’ need for intensive care unit (ICU) admission. A retrospective analysis was conducted at four training and research hospitals’ emergency departments (EDs) on all EPN adult patients from January 2007 to August 2017. Data extracted were used to calculate raw scores for five physiologic scoring systems. Mann-Whitney U tests and χ2 tests were done for numerical and categorical variables respectively to examine differences between characteristics of ICU and non-ICU patient populations. Predictability of ICU admission was evaluated with AUROC analysis. ICU patients had lower GCS scores, SpO2, platelet counts, and estimated glomerular filtration rate; and higher bands, blood urea nitrogen, creatinine, and incidences of septic shock and nephrectomy. NEWS performed best, with 73.85% accuracy at optimal cut-off of 3. In this multicentre ED EPN series, we recommend using NEWS in early identification of critical EPN patients and advance planning for ICU admission. This would reduce delays in ICU transfer and ultimately improve patient outcomes.

scholarly journals Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024636 ◽  
Author(s):  
Andreas Eckart ◽  
Stephanie Isabelle Hauser ◽  
Alexander Kutz ◽  
Sebastian Haubitz ◽  
Pierre Hausfater ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Risk Stratification ◽  
Early Warning ◽  
Inflammatory Markers ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Secondary Outcome ◽  
Icu Admission ◽  
National Early Warning Score

ObjectivesThe National Early Warning Score (NEWS) helps to estimate mortality risk in emergency department (ED) patients. This study aimed to investigate whether the prognostic value of the NEWS at ED admission could be further improved by adding inflammatory blood markers (ie, white cell count (WCC), procalcitonin (PCT) and midregional-proadrenomedullin (MR-proADM).DesignSecondary analysis of a multinational, observational study (TRIAGE study, March 2013–October 2014).SettingThree tertiary care centres in France, Switzerland and the USA.ParticipantsA total of 1303 adult medical patients with complete NEWS data seeking ED care were included in the final analysis. NEWS was calculated retrospectively based on admission data.Main outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcome was intensive care unit (ICU) admission. We used multivariate regression analyses to investigate associations of NEWS and blood markers with outcomes and area under the receiver operating curve (AUC) as a measure of discrimination.ResultsOf the 1303 included patients, 54 (4.1%) died within 30 days. The NEWS alone showed fair prognostic accuracy for all-cause 30-day mortality (AUC 0.73), with a multivariate adjusted OR of 1.26 (95% CI 1.13 to 1.40, p<0.001). The AUCs for the prediction of mortality using the inflammatory markers WCC, PCT and MR-proADM were 0.64, 0.71 and 0.78, respectively. Combining NEWS with all three blood markers or only with MR-proADM clearly improved discrimination with an AUC of 0.82 (p=0.002). Combining the three inflammatory markers with NEWS improved prediction of ICU admission (AUC 0.70vs0.65 when using NEWS alone, p=0.006).ConclusionNEWS is helpful in risk stratification of ED patients and can be further improved by the addition of inflammatory blood markers. Future studies should investigate whether risk stratification by NEWS in addition to biomarkers improve site-of-care decision in this patient population.Trial registration numberNCT01768494; Post-results.

scholarly journals Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients with COVID-19

2021 ◽  
Author(s):  
Ryan C Maves ◽  
Stephanie A Richard ◽  
David A Lindholm ◽  
Nusrat Epsi ◽  
Derek T Larson ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Early Warning ◽  
Predictive Value ◽  
Early Recognition ◽  
Invasive Mechanical Ventilation ◽  
Scoring Systems ◽  
Early Warning Score ◽  
Low Flow ◽  
Invasive Ventilation ◽  
Military Health

Abstract Background Early recognition of high-risk patients with COVID-19 may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter U.S. Military Health System (MHS) observational cohort study. Methods Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and a baseline NEWS were included. We analyzed each scoring system’s ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low (0-3), medium (4-6) and high (≥7)). Results Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (p&lt;0.01) and lower maximum illness severity (p&lt;0.001). Most (80.2%) of low NEWS versus 15.8% of high NEWS participants required no or at most low flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: AUROC 0.69; 95% CI 0.65-0.73; NEWS: AUROC 0.70; 0.66-0.75). Conclusions NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.

scholarly journals Prognostic Accuracy of the Quick Sequential Organ Failure Assessment Score and National Early Warning Scores in mortality rate of the Non-Traumatic Patients

2021 ◽  
Author(s):  
Kavous Shahsavarinia ◽  
Aydin Mahmoud Alilou ◽  
Sevil Mahmoud Alilou ◽  
Parinaz Mahmoud Alilou ◽  
Afshin Gharekhani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Early Warning ◽  
Demographic Data ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Main Diagnosis ◽  
Cross Sectional ◽  
Failure Assessment

Background: The current study aimed to evaluate the predictive value of mortality in patients admitted to the Intensive Care Unit (ICU) through the emergency department and based on Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS) and NEWS2 criteria. Methods: In this cross-sectional study, all patients referred to the emergency department with a need of admission to ICU for any reason, were evaluated. Demographic data such as age and sex were recorded for data collection. Also, the main diagnosis, length of stay and hospitalization outcome along with data related to qSOFA, NEWS and NEWS2 indices were included in the researcher's checklist. Results: Of 89 included patients, 52 (58.4%) were male and 37 (41.6%) were female, with mean age of 60.25±20.8. Our findings indicated that qSOFA is a good predictor for mortality in non-traumatic patients so that qSOFA has 48% sensitivity and 100% specificity in the diagnosis of mortality in non-trauma patients. NEWS also has a sensitivity of 72% and a specificity of 71.4% in the diagnosis of non-traumatic mortality. And NEWS2 has 72% sensitivity and 78.6% specificity in non-traumatic mortality diagnosis. Conclusion: Our findings suggested that the sensitivity and specificity of qSOFA, NEWS and NEWS2 in predicting the mortality of non-traumatic patients who were admitted in emergency departments and hospitalized in ICU, are high and reliablen.

scholarly journals Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0211133 ◽  
Author(s):  
Anniek Brink ◽  
Jelmer Alsma ◽  
Rob Johannes Carel Gerardus Verdonschot ◽  
Pleunie Petronella Marie Rood ◽  
Robert Zietse ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Early Warning ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Warning Score ◽  
Suspected Sepsis ◽  
National Early Warning Score

The Use of Prognostic Prediction Models for Mortality or Clinical Deterioration among Hospitalized and Non-hospitalized Adults with COVID-19: A Systematic Review

2021 ◽  
Author(s):  
Patricia Pauline M. Remalante-Rayco ◽  
Evelyn Osio-Salido
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Early Warning ◽  
Prediction Models ◽  
External Validation ◽  
Risk Of Bias ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Good Prediction ◽  
Prediction Of Mortality

Objective. To assess the performance of prognostic models in predicting mortality or clinical deterioration among patients with COVID-19, both hospitalized and non-hospitalized Methods. We conducted a systematic review of the literature until March 8, 2021. We included models for the prediction of mortality or clinical deterioration in COVID-19 with external validation. We used the Prediction model Risk Of Bias ASsessment Tool (PROBAST) and the GRADEpro Guideline Development Tool (GDT) to assess the evidence obtained. Results. We reviewed 33 cohort studies. Two studies had a low risk of bias, four unclear risks, and 27 with a high risk of bias due to participant selection and analysis. For the outcome of mortality, the QCOVID model had excellent prediction with high certainty of evidence but was specific for use in England. The COVID Outcome Prediction in the Emergency Department (COPE) model, the 4C Mortality Score, the Age, BUN, number of comorbidities, CRP, SpO2/FiO2 ratio, platelet count, heart rate (ABC2-SPH) risk score, the Confusion Urea Respiration Blood Pressure (CURB-65) severity score, the Rapid Emergency Medicine Score (REMS), and the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) score had fair to good prediction of death among inpatients, while the quick Sepsis-related Organ Failure Assessment (qSOFA) score had poor to fair prediction. The certainty of evidence for these models was very low to low. For the outcome of clinical deterioration, the 4C Deterioration Score had fair prediction, the National Early Warning Score 2 (NEWS2) score poor to good, and the Modified Early Warning Score (MEWS) had poor prediction. The certainty of evidence for these three models was also very low to low. None of these models had been validated in the Philippine setting. Conclusion. The QCOVID, COPE, ABC2-SPH, 4C, CURB-65, REMS, RISE-UP models for prediction of mortality and the 4C Deterioration and NEWS2 models for prediction of clinical deterioration are potentially useful but need to be validated among patients with COVID-19 of varying severity in the Philippine setting.

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