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Background: Coronavirus disease 2019 (COVID-19) infection has a wide range of severity, ranging from asymptomatic infection to severe respiratory distress and multiple organ dysfunction. To optimize the utilization of limited resources, a system is needed to rapidly classify the patients requiring monitoring and urgent intervention. The purpose of this study was to determine whether the National Early Warning Score (NEWS) at admission is a useful prediction tool for in-hospital mortality in patients who visited the emergency department (ED) and required isolation during the COVID-19 pandemic. Methods: This study was conducted in adults aged 19 years or older who visited the ED and were preemptively isolated due to fever or respiratory symptoms from January 2021 to December 2021. The NEWS was calculated at the time of ED admission. The primary outcome was all-cause inhospital mortality. Results: Of the 6304 patients included in the study, 5759 survived and 545 died in the hospital. The NEWS was higher in non-survivors (6.1 ± 4.2) than in survivors (2.8 ± 2.5). When the NEWS was examined as a continuous variable, the adjusted odds ratio for in-hospital mortality was 1.176 (95% CI, 1.12-1.23). The area under the curve (AUC) of NEWS for predicting inhospital mortality was 0.756 (95% CI, 0.734-0.778). Conclusions: The NEWS at ED admission was associated with in-hospital mortality in preemptively isolated patients during the COVID-19 pandemic. The use of NEWS in patients with suspected COVID-19 infection would help predict the severity and prognosis of patients. [ABSTRACT FROM AUTHOR]

Aims: To explore Registered Nurses' experiences and perceptions with National Early Warning Score and Individual Early Warning Score to identify patient deterioration. Design: A qualitative exploratory design. Methods: Six focus groups were conducted at six Danish hospitals from February to June 2019. Registered Nurses from both medical, surgical and emergency departments participated. The focus groups were analysed using content analysis. Results: One theme and four categories were identified. Theme: Meaningful in identifying patient deterioration but causing frustration due to lack of flexibility. Categories: (a) Inter‐professional collaboration strengthened through the use of Early Warning Score systems, (b) Enhanced professional development and communication among nurses when using Early Warning Score systems, (c) Detecting patient deterioration by integrating nurses' clinical gaze with Early Warning Score systems and (d) Modification and fear of making mistakes when using Early Warning Score systems. [ABSTRACT FROM AUTHOR]

Aim: The older adult population is continuously growing worldwide and there is increasing use of medical recourse in older patients, especially for those requiring intensive care unit (ICU) care and mechanical ventilation (MV). The present study aimed to investigate the burden and predictors of post‐ICU respiratory failure in older ICU patients weaned from MV. Methods: In the present retrospective study, older ICU patients aged ≥60 years, who were successfully weaned from MV and discharged to the general ward from the ICU of Taipei Veterans General Hospital, Taipei, Taiwan, in 2011, were included. Biomarkers on ICU discharge, as well as the National Early Warning Score (NEWS) were recorded and calculated. The outcome measure was post‐ICU respiratory failure before day 14 (PIRF‐14) requiring reinstitution of MV. Logistical regression was used to assess the predictors for PIRF‐14. Results: Of 272 patients included, 23 (8.5%) developed PIRF‐14. The post‐ICU in‐hospital mortality rates were 47.8% and 6.8% in patients with and without PIRF‐14 (adjusted OR 12.597, 95% CI 4.368–36.331). In a multivariate analysis, the levels of NEWS and hemoglobin on ICU discharge were independent predictors for PIRF‐14 (adjusted OR 1.273, 95% CI 1.076–1.507 and 0.645, 95% CI 0.474–0.879). In particular, patients with a NEWS of ≥10 and subsequent PIRF‐14 had a 15‐fold increased risk of mortality as compared with those without both factors (adjusted OR 15.418, 95% CI 4.344–54.720). Conclusions: PIRF‐14 is associated with high mortality in older ICU patients, and NEWS is a significant predictor for PIRF‐14, which could be used to early identify patients at risk of post‐ICU respiratory failure in the specific population. Geriatr Gerontol Int 2019; 19: 317–322. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events.Methods: Point prevalence study of vital parameters according to NEWS and RRT criteria of all adult patients admitted to general wards at a Scandinavian university hospital with a mature RRT.Primary Outcome: prevalence of at-risk patients fulfilling at least one RRT criteria, total NEWS of 7 or greater or a single NEWS parameter of 3 (red NEWS).Secondary Outcomes: mortality in-hospital and within 30 days or adverse events within 24 hours.Results: We assessed 598 (75%) of 798 admitted patients and examiners captured a fulfilled RRT calling criterion in 50 patients (8.4%), 36 (6.0%) had NEWS ≥ 7, 34 with a red NEWS parameter. Red NEWS occurred in 112 patients (18.7%). Secondary outcomes were fulfilled in 49 patients (8.2%). Mortality overall was 6.5% within 30 days, 1.8% in hospital. In 134 patients (22.4%) the manual calculation of score for NEWS was incorrectly performed by examiner.Conclusion: Even with a mature RRT in place, we captured patients with failing physiology in general wards reflecting afferent limb failure. Manual calculation of NEWS is frequently incorrect, possibly leading to misclassification of patients at risk. [ABSTRACT FROM AUTHOR]

Background: For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II. Objectives: To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms. Methods: A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality. Results: For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group (p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 (p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant (p < 0.05). Conclusion: The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room. [ABSTRACT FROM AUTHOR]

Background: No risk stratification tool has been validated in hospitalised patients with coronavirus disease 2019 (COVID-19), despite a high rate of intensive care requirement and in-hospital mortality. We aimed to determine whether the National Early Warning Score (NEWS) at admission can accurately predict in-hospital mortality and ICU transfer.Methods: This was a retrospective cohort study from January 24 to April 16, 2020, at Lille University Hospital. All consecutive adult patients with laboratory-confirmed COVID-19 who were initially admitted to non-ICU wards were included. The primary outcome was a composite criterion consisting of ICU transfer or in-hospital mortality. We evaluated the prognostic performance of NEWS by calculating the area under (AUC) the receiver operating characteristic curve, the optimal threshold value of NEWS, and its association with the primary outcome.Results: Of the 202 COVID-19 patients, the median age was 65 (interquartile range 52-78), 38.6% were women and 136 had at least one comorbidity. The median NEWS was 4 (2-6). A total of 65 patients were transferred to the ICU or died in the hospital. Compared with patients with favourable outcome, these patients were significantly older, had more comorbidities and higher NEWS. The AUC for NEWS was 0.68 (0.60-0.77) and the best cutoff value was 6. Adjusted odds ratio for NEWS ≥ 6 as an independent predictor was 3.78 (1.94-7.09).Conclusions: In hospitalised COVID-19 patients, NEWS was an independent predictor of ICU transfer and in-hospital death. In daily practice, NEWS ≥ 6 at admission may help to identify patients who are at risk to deteriorate. [ABSTRACT FROM AUTHOR]