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Observational Study
. 2019 Jan:134:147-156.
doi: 10.1016/j.resuscitation.2018.09.026. Epub 2018 Oct 1.

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

Marco A F Pimentel  1 , Oliver C Redfern  2 , Stephen Gerry  3 , Gary S Collins  3 , James Malycha  4 , David Prytherch  2 , Paul E Schmidt  5 , Gary B Smith  6 , Peter J Watkinson  4
Affiliations
Observational Study

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

Marco A F Pimentel et al. Resuscitation. 2019 Jan.

Abstract

Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes.

Methods: We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation. Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic.

Results: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination.

Conclusions: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

Keywords: COPD; Early warning score; Physiological monitoring; Vital signs.

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Figures

Fig. 1
Fig. 1
Flowchart showing application of exclusion criteria for obtaining the admissions included in the analysis.
Fig. 2
Fig. 2
Representation of the normalised histograms of oxygen saturation (SpO2) recorded for each of the risk groups. For each bar, the relative proportion of measurements performed while patients were on oxygen (O2) or on air is shown.
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curve for NEWS and NEWS2 (with scale2), for discriminating vital signs observations followed by in-hospital death within the following 24 h for the three risk groups (from top to bottom): admissions with documented type II respiratory failure (T2RF), admissions at risk of T2RF, and admissions not at risk of T2RF. Sensitivity and 1–Specificity are shown in %.
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References

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