The National Early Warning Score predicts mortality in hospital ward patients with deviating vital signs: A retrospective medical record review study

Abstract

Aims and objectives: To evaluate whether the scale used for assessment of hospital ward patients could predict in-hospital and 30-day mortality amongst those with deviating vital signs; that is, that patients classified as medium or high risk would have increased risk of in-hospital and 30-day mortality compared to patients with low risk.

Background: The National Early Warning Score (NEWS) is a widely adopted scale for assessing deviating vital signs. A clinical risk scale that comes with the NEWS divides the risk for critical illness into three risk categories, low, medium and high.

Design: Retrospective analysis of vital sign data.

Methods: Logistic regression models for age-adjusted in-hospital and 30-day mortality were used for analyses of 1,107 patients with deviating vital signs.

Results: Patients classified as medium or high risk by NEWS experienced a 2.11 or 3.40 increase, respectively, in odds of in-hospital death (95% CI: 1.27-3.51, p = 0.004% and 95% CI: 1.90-6.01, p < 0.001) compared to low-risk patients. Moreover, those with NEWS medium or high risk were associated with a 1.98 or 3.19 increase, respectively, in odds of 30-day mortality (95% CI: 1.32-2.97, p = 0.001% and 95% CI: 1.97-5.18, p < 0.001).

Conclusion: The NEWS risk classification seems to be a reliable predictor of mortality on patients in hospital wards.

Relevance to clinical practice: The NEWS risk classification offers a simple way to identify deteriorating patients and can aid the healthcare staff to prioritise amongst patients.

Keywords: Early Warning Score; Medical Emergency Team; National Early Warning Score; critical care; critical care outreach; hospital mortality; in-hospital cardiac arrest; vital signs.