Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/126507
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Type: Journal article
Title: 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
Author: Pimentel, M.A.
Redfern, O.C.
Gerry, S.
Collins, G.S.
Malycha, J.
Prytherch, D.
Schmidt, P.E.
Smith, G.B.
Watkinson, P.J.
Citation: Resuscitation, 2019; 134:147-156
Publisher: Elsevier
Issue Date: 2019
ISSN: 0300-9572
1873-1570
Statement of
Responsibility: 
Marco A.F. Pimentel, Oliver C. Redfern, Stephen Gerry, Gary S. Collins, James Malycha, David Prytherch ... et al.
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: Humans; Respiratory Insufficiency; Heart Arrest; Hospital Mortality; Risk Assessment; Sensitivity and Specificity; Retrospective Studies; ROC Curve; Aged; Aged, 80 and over; Middle Aged; Female; Male; Early Warning Score
Rights: © 2018 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
RMID: 1000022479
DOI: 10.1016/j.resuscitation.2018.09.026
Appears in Collections:Medicine publications

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