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In 2012, the National Early Warning Score (NEWS) was introduced to standardise monitoring of vital signs and improve patient safety in acute hospitals. By 2017 around two-thirds of NHS hospitals were using NEWS and an updated version, NEWS2, was released. In 2019 all acute hospital trusts and ambulance services were required to use NEWS2. Now NEWS2 is being used increasingly in care homes and community settings. People living in care homes are often frail and have multiple healthcare conditions. NEWS was never designed to monitor the health of older people, but it has the potential to improve care by enabling staff to identify people who are becoming unwell and to provide care within care homes and the person's own home. However, if it is not introduced with care, it could lead to an increase in the number of people attending accident and emergency departments. This article examines the emerging evidence base and concludes that appropriate support and advanced care planning are of crucial importance. [ABSTRACT FROM AUTHOR]

Previous studies have shown that an elevated prehospital National Early Warning Score (preNEWS) is associated with increased levels of adverse outcomes in patients with trauma. However, whether preNEWS is a predictor of massive transfusion (MT) in patients with trauma is currently unknown. This study investigated the accuracy of preNEWS in predicting MT and hospital mortality among trauma patients. We analyzed adult trauma patients who were treated and transported by emergency medical services (EMS) between January 2018 and December 2019. The main exposure was the preNEWS calculated for the scene. The primary outcome was the predictive ability for MT, and the secondary outcome was 24 h mortality. We compared the prognostic performance of preNEWS with the shock index, modified shock index, and reverse shock index, and reverse shock index multiplied by Glasgow Coma Scale in the prehospital setting. In total, 41,852 patients were included, and 1456 (3.5%) received MT. preNEWS showed the highest area under the receiver operating characteristic (AUROC) curve for predicting MT (0.8504; 95% confidence interval [CI], 0.840–0.860) and 24 h mortality (AUROC 0.873; 95% CI, 0.863–0.883). The sensitivity of preNEWS for MT was 0.755, and the specificity of preNEWS for MT was 0.793. All indicies had a high negative predictive value and low positive predictive value. preNEWS is a useful, rapid predictor for MT and 24 h mortality. Calculation of preNEWS would be helpful for making the decision at the scene such as transfer straightforward to trauma center and advanced treatment. [ABSTRACT FROM AUTHOR]

Data on patient characteristics and determinants of serious outcomes for acutely admitted patients with infections who do not fulfill the sepsis criteria are sparse. The study aimed to characterize acutely admitted emergency department (ED) patients with infections and a composite outcome of in-hospital mortality or transfer to the intensive care unit without fulfilling the criteria for sepsis and to examine predictors of the composite outcome. This was a secondary analysis of data from a prospective observational study of patients with suspected bacterial infection admitted to the ED between October 1, 2017 and March 31, 2018. A National Early Warning Score 2 (NEWS2) ≥ 5 within the first 4 h in the ED was assumed to represent a sepsis-like condition with a high risk for the composite endpoint. Patients who achieved the composite outcome were grouped according to fulfillment of the NEWS2 ≥ 5 criteria. We used logistic regression analysis to estimate the unadjusted and adjusted odds ratio (OR) for the composite endpoint among patients with either NEWS2 < 5 (NEWS2-) or NEWS2 ≥ 5 (NEWS2+). A total of 2055 patients with a median age of 73 years were included. Of these, 198 (9.6%) achieved the composite endpoint, including 59 (29.8%) NEWS2- and 139 (70.2%) NEWS2+ patients, respectively. Diabetes (OR 2.23;1.23–4.0), a Sequential Organ Failure Assessment (SOFA) score ≥ 2 (OR 2.57;1.37–4.79), and a Do-not-attempt-cardiopulmonary-resuscitation order (DNACPR) on admission (OR 3.70;1.75–7.79) were independent predictive variables for the composite endpoint in NEWS2- patients (goodness-of-fit test P = 0.291; area under the receiver operating characteristic curve for the model (AUROC) = 0.72). The regression model for NEWS2+ patients revealed that a SOFA score ≥ 2 (OR 2.79; 1.59–4.91), hypothermia (OR 2.48;1.30–4.75), and DNACPR order on admission were predictive variables for the composite endpoint (goodness-of-fit test P = 0.62; AUROC for the model = 0.70). Approximately one-third of the patients with infections and serious outcomes during hospitalization did not meet the NEWS2 threshold for likely sepsis. Our study identified factors with independent predictive values for the development of serious outcomes that should be tested in future prediction models. [ABSTRACT FROM AUTHOR]

Objective: Copeptin, reflecting vasopressin release, as well as the National Early Warning Score (NEWS), reflecting the severity of critical illness, might qualify for survival prediction in elderly patients with critical illness. This prospective observational study aims at assessing the predictive value of copeptin combined with NEWS on the prognosis of elderly critical ill patients at emergency department (ED).Methods: We analyzed serum copeptin levels and the NEWS at admission to the ED in a prospective, single-center, and observational study comprising 205 elderly patients with critical illness. Death within 30 days after admission to the ED was the primary end point.Results: The serum copeptin levels and the NEWS in the non-survivor patients group were higher than those in the survivor group [30.35 (14.20, 38.91) vs 17.53 (13.01, 25.20), P = 0.001 and 9.0 (7.0-10.0) vs 7.0 (6.0-8.0), P = 0.001]. Multivariate logistic regression analysis showed that copeptin, NEWS and copeptin combined with NEWS were all independent risk factors for 30-day mortality in elderly patients with critical illness. Copeptin, NEWS and copeptin combined with NEWS all performed well in predicting 30-day survival, with area under the ROC curve (AUC) values of 0.766 (95%CI, 0.702-0.822), 0.797 (95%CI, 0.744-0.877) and 0.854 (95%CI, 0.798-0.899) respectively. Using the Z test to compare the areas under the above three curves, copeptin combined with NEWS showed a higher predictive value for 30-day survival (P < 0.05). As we calculated, the optimal cut-off values of copeptin and NEWS using the Youden index were 19.78 pg/mL and 8.5 points, respectively. Risk stratification analysis showed that patients with both copeptin levels higher than 19.78 pg/mL and NEWS points higher than 8.5 points had the highest risk of death.Conclusions: Copeptin combined with NEWS have a stronger predictive power on the prognosis of elderly patients with critical illness at ED, comparing to either factor individually. [ABSTRACT FROM AUTHOR]

This study aimed to develop a new model on the basis of the National Early Warning Score to predict intensive care unit admission and the mortality of patients with acute pancreatitis. Patients diagnosed with acute pancreatitis in the emergency department were enrolled. The values of the National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis in predicting intensive care unit admission and mortality of patients with acute pancreatitis were evaluated. A total of 379 patients with acute pancreatitis were enrolled; 77 patients (20.3%) were admitted to the intensive care unit and 14 (3.7%) died. The National Early Warning Score and calcium level were identified as independent risk factors of intensive care unit admission. Serum calcium exhibited a moderate correlation with National Early Warning Score (r = -0.46; P < 0.001), Modified Early Warning Score (r = -0.37; P < 0.001), and Bedside Index of Severity in Acute Pancreatitis (r = -0.39; P < 0.001). A new model called National Early Warning Score-calcium was developed by combining National Early Warning Score and calcium blood test result, which had larger areas under the curve for predicting intensive care unit admission and mortality than the other 3 scoring systems. A new model developed by combining National Early Warning Score and calcium exhibited better value in predicting the prognosis of acute pancreatitis than the models involving National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis alone. [ABSTRACT FROM AUTHOR]

The National Early Warning Score - NEWS is a "track and trigger" scale designed to assess in-hospital patients' vital signs and detect clinical deterioration. In this study the NEWS was translated into Swedish and its association with the need of intensive care was investigated. A total of 868 patient charts, recorded by the medical emergency team at a university hospital, containing the parameters needed to calculate the NEWS were audited. The NEWS was translated into Swedish and tested for inter-rater reliability with a perfect agreement (weighted K = 1.0) among the raters. The median score for patients admitted to the ICU were higher than for those who were not (10 vs. 8, p < 0.0001). AUROCfor discriminating admittance to the ICU was 0.68 (95% CI: 0.622-0.739, p < 0.0001). A regression analysis showed that lower oxygen saturation and a lower level of consciousness were significantly associated with ICU admission (OR 1.27 [1.06-1.52], p = 0.01 and OR 1.77 [1.12-2.82], p = 0.02) and may predict admission to the ICU better than the other parameters. The Swedish translated NEWS seems to have excellent inter-rater reliability and can be used without risk of linguistic misinterpretation. High scores for the parameters oxygen saturation and level of consciousness in the NEWS may predict admission to the ICU. [ABSTRACT FROM AUTHOR]

• Various unexpected events may occur at any time during Intrahospital transport. • An appropriate scoring tool should be used to assess the patient's basic condition. • The Worthing Physiological Scoring System is a simple and suitable tool. The aim of this study was to assess the value of the National Early Warning Score and Worthing Physiological Scoring System for predicting changes in the condition of critical cases during transfer from the emergency department to the intensive care unit. This prospective single-centre study was conducted at a 1759-bed hospital in Beijing. We recorded the vital signs in the cases before leaving the emergency department and their changes in condition during transit. A total of 258 critically ill cases were included. Forty-four cases (17.05%) exhibited changes in their condition during transit. Compared with cases with NEWS ≤ 5, cases with NEWS > 5 were more likely to experience changes with an OR of 5.744 (95% CI 2.888–11.426). Compared with cases with WPS ≤ 2, cases with WPS > 2 were more likely to experience changes with an OR of 7.217 (95% CI 3.575–14.569). The difference between the areas under the curve of the NEWS (0.751 ± 0.045) and the WPS (0.736 ± 0.045) was not statistically significant (P = 0.4518). In our study, the Worthing Physiological Scoring System and National Early Warning Score both exhibited good discriminatory power, but the Worthing Physiological Scoring System is simpler to use and more suitable for use in a busy emergency department. [ABSTRACT FROM AUTHOR]

Limited research exists on the effectiveness of the New Zealand Early Warning Score (NZEWS). To determine the impact of a modified NZEWS (M–NZEWS) and NZEWS on ward patients' medical emergency team activation triggers. Mixed methods sequential design. Three phases included: 1) review of M–NZEWS electronic data to determine the effect of a M–NZEWS and NZEWS on ward patients; 2) an in-depth review of 20 Māori patients allocated to lower escalation zones if the NZEWS were adopted and 3) the number of electronic medical emergency team activation triggers compared to the number of actual medical emergency team activations. 1255 patients and 3505 vital sign data sets were analysed. Adopting the NZEWS would result in 396 (26.8%) fewer patients triggering a medical emergency team activation. The biggest impact would be on Māori, with 38.6% of Māori allocated to a lower escalation zone. Only 51.2% of patients with a medical emergency team activation had vital signs triggering the response electronically documented. Changing from the M–NZEWS to NZEWS will reduce the number of medical emergency team activation triggers, with the biggest impact on Māori. Electronic vital sign data does not accurately reflect the number of ward medical emergency team triggers or activations. [ABSTRACT FROM AUTHOR]