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Lan Chen,1 Han Zheng,2 Lijun Chen,2 Sunying Wu,2 Saibin Wang3 1Nursing Education Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, People’s Republic of China; 2Emergency Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, People’s Republic of China; 3Department of Respiratory Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, 321000, Zhejiang Province, People’s Republic of ChinaCorrespondence: Saibin WangDepartment of Respiratory Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, People’s Republic of ChinaTel +86 579 82552278Fax +86 579 82325006Email saibinwang@hotmail.comBackground: For emergency triage, it is very important to identify patient severity according to their vital signs and chief complaint. Several studies have examined the predictive value of the National Early Warning Score (NEWS) for specific emergency patients and have shown it to be effective. However, few have studied the utility of NEWS in emergency triage for general emergency medicine patients. The aim of this research was to investigate the performance of NEWS in emergency triage with regard to predicting adverse outcomes.Methods: This was a retrospective cohort study carried out at a tertiary care center hospital in Jinhua, China. A total of 62,403 patients attending the emergency department (ED) from January to December 2018 were included. The NEWS, Modified Early Warning Score (MEWS), and quick Sepsis Related Organ Failure Assessment (qSOFA) score were obtained from emergency triage. Multivariate logistic regression analysis was performed to evaluate the associations between the NEWS, MEWS, and qSOFA, as well as those between other parameters with ED mortality. The predictive performances for emergency observation, death, and intensive care unit (ICU) admission of NEWS, MEWS and qSOFA were compared to the area under the receiver operating characteristic curve (AUROC).Results: Of the total participants, 6502 were placed under emergency observation, 106 died in the ED, 638 were admitted to the ICU, and 324 died in-hospital. The NEWS, qSOFA, age, and gender were significantly associated with ED mortality. NEWS was significantly better at discriminating all outcomes, and the area under the curve and 95% confidence intervals for ED mortality, observation in ED, composite of ED mortality and ICU admission, and in-hospital mortality were 0.862 (0.859– 0.865), 0.691 (0.687– 0.695), 0.859 (0.856– 0.861), and 0.805 (0.802– 0.808), respectively.Conclusion: NEWS shows good performance in discriminating critical emergency patients in ED triage for emergency medicine patients.Keywords: National Early Warning Score, triage, emergency department, predict, outcomes

ObjectiveDuring the influenza epidemic season, the fragile elderlies are not only susceptible to influenza infections, but are also more likely to develop severe symptoms and syndromes. Such circumstances may pose a significant burden to the medical resources especially in the emergency department (ED). Disposition of the elderly patients with influenza infections to either the ward or intensive care unit (ICU) accurately is therefore a crucial issue.Study designRetrospective cohort study.Setting and participantsElderly patients (≥65 years) with influenza visiting the ED of a medical centre between 1 January 2010 and 31 December 2015.Primary outcome measuresDemographic data, vital signs, medical history, subtype of influenza, national early warning score (NEWS) and outcomes (mortality) were analysed. We investigated the ability of NEWS to predict ICU admission via logistic regression and the receiver operating characteristic (ROC) analysis.ResultsWe included 409 geriatric patients in the ED with a mean age of 79.5 years and approximately equal sex ratio. The mean NEWS ±SD was 3.4±2.9, and NEWS ≥8 was reported in 11.0% of the total patients. Logistic regression revealed that NEWS ≥8 predicted ICU admission with an OR of 5.37 (95% CI 2.61 to 11.04). The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.95, and the adjusted area under the ROC was 0.72. An NEWS ≥8 is associated with ICU-admission and may help to triage elderly patients with influenza infections during the influenza epidemic season.ConclusionThe high specificity of NEWS ≥8 to predict ICU admission in elderly patients with influenza infection during the epidemic season may avoid unnecessary ICU admissions and ensure proper medical resource allocation.

The coronavirus disease (COVID-19) has become a global pandemic. Invasive mechanical ventilation is recommended for the management of patients with COVID-19 who have severe respiratory symptoms. However, various complications can develop after its use. The efficient and appropriate management of patients requires the identification of factors associated with an aggravation of COVID-19 respiratory symptoms to a degree where invasive mechanical ventilation becomes necessary, thereby enabling clinicians to prevent such ventilation. This retrospective study included 138 inpatients with COVID-19 at a tertiary hospital. We evaluated the differences in the demographic and clinical data between 27 patients who required invasive mechanical ventilation and 111 patients who did not. Multivariate logistic regression analysis indicated that the duration of fever, national early warning score (NEWS), and lactate dehydrogenase (LDH) levels on admission were significantly associated with invasive mechanical ventilation in this cohort. The optimal cut-off values were: fever duration ≥1 day (sensitivity 100.0%, specificity 54.95%), NEWS ≥7 (sensitivity 72.73%, specificity 92.52%), and LDH >810 mg/dL (sensitivity 56.0%, specificity 90.29%). These findings can assist in the early identification of patients who will require invasive mechanical ventilation. Further studies in larger patient populations are recommended to validate our findings.

Introduction The medical emergency team enables the limitation of patients’ progression to critical illness in the general ward. The early warning scoring system (EWS) is one of the criteria for medical emergency team activation; however, it is not a valid criterion to predict the prognosis of patients with MET activation. Aim In this study, the National Early Warning Score (NEWS) and Rapid Emergency Medicine Score (REMS) was compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting the prognosis of patients who had been treated a medical emergency team. Material and Methods In this single-centre retrospective cohort study, patients treated by a medical emergency team between April 2013 and March 2019 and the 28-day prognosis of MET-activated patients were assessed using APACHE II, NEWS, and REMS. Results Of the 196 patients enrolled, 152 (77.5%) were men, and 44 (22.5%) were women. Their median age was 68 years (interquartile range: 57-76 years). The most common cause of medical emergency team activation was respiratory failure (43.4%). Univariate analysis showed that APACHE II score, NEWS, and REMS were associated with 28-day prognostic mortality. There was no significant difference in the area under the receiver operating characteristic curve of APACHE II (0.76), NEWS (0.67), and REMS (0.70); however, the sensitivity of NEWS (0.70) was superior to that of REMS (0.47). Conclusion NEWS is a more sensitive screening tool like APACHE II than REMS for predicting the prognosis of patients with medical emergency team activation. However, because the accuracy of NEWS was not sufficient compared with that of APACHE II score, it is necessary to develop a screening tool with higher sensitivity and accuracy that can be easily calculated at the bedside in the general ward.

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.

Background SARS-CoV-2 strains healthcare capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory can ease this burden. Elevated blood soluble urokinase plasminogen activator receptor (suPAR) has previously been shown associated with risk of intubation in confirmed COVID-19 patients. Objective To evaluate if point-of-care measures of suPAR in patients presenting at the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19th to April 3rd, 2020. Soluble urokinase plasminogen activator receptor was measured at first presentation. Review of electronic patient records 14 days after admission were used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National early warning score (NEWS), C-reactive protein (CRP), and duration of symptoms (DOS) was calculated using receiver operating characteristics (ROC). Results Of 386 patients, 171 (44%) patients had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR

This thesis investigates the role of the national early warning score (news) in identifying and predicting sepsis or septic shock at an early stage at the emergency department. A bibliographical literature review helped to identify and compare several articles which examined the this score in the emergency room. The findings were summarised and discussed in a structural manner to formulate a valuable conclusion for the role of the national early warning score.

BackgroundNHS England has mandated use of the National Early Warning Score (NEWS), more recently NEWS2, in acute settings, and suggested its use in primary care. However, there is reluctance from GPs to adopt NEWS/NEWS2.AimTo assess whether NEWS calculated at the point of GP referral into hospital is associated with outcomes in secondary care.Design and settingAn observational study using routinely collected data from primary and secondary care.MethodNEWS values were prospectively collected for 13 047 GP referrals into acute care between July 2017 and December 2018. NEWS values were examined and multivariate linear and logistic regression used to assess associations with process measures and clinical outcomes.ResultsHigher NEWS values were associated with faster conveyance for patients travelling by ambulance, for example, median 94 minutes (interquartile range [IQR] 69–139) for NEWS ≥7; median 132 minutes, (IQR 84–236) for NEWS = 0 to 2); faster time from hospital arrival to medical review (54 minutes [IQR 25–114] for NEWS ≥7; 78 minutes [IQR 34–158] for NEWS = 0 to 2); as well as increased length of stay (5 days [IQR 2–11] versus 1 day [IQR 0–5]); intensive care unit admissions (2.0% versus 0.5%); sepsis diagnosis (11.7% versus 2.5%); and mortality, for example, 30-day mortality 12.0% versus 4.1% for NEWS ≥7 versus NEWS = 0 to 2, respectively. On average, for patients referred without a NEWS value (NEWS = NR), most clinical outcomes were comparable with patients with NEWS = 3 to 4, but ambulance conveyance time and time to medical review were comparable with patients with NEWS = 0 to 2.ConclusionThis study has demonstrated that higher NEWS values calculated at GP referral into hospital are associated with a faster medical review and poorer clinical outcomes.

Enquadramento: Os enfermeiros desempenham um papel fundamental na vigilância e monitorização da pessoa em situação crítica e, consequentemente, no despiste de complicações que podem comprometer a sua saúde e retardar a recuperação. De acordo com vários autores, as alterações fisiológicas que traduzem deterioração orgânica permitem detetar antecipadamente as pessoas em situação crítica. Neste sentido, foram desenvolvidas escalas de alerta precoce, sendo o National Early Warning Score um desses instrumentos. Objetivo: Uniformizar a avaliação das pessoas em situação crítica internadas em sala de observação no serviço de urgência geral de um centro hospitalar. Metodologia: Projeto de intervenção em serviço assente na metodologia de projeto. Resultados: A colheita de dados foi realizada em três momentos diferentes. Após a análise foi identificado que mais de 50% das pessoas não foram alocadas adequadamente. No primeiro momento de colheita, o resultado foi de 52%, no segundo de 57,1% e no terceiro de 75%. A implementação do National Early Warning Score não foi possível devido à elevada carga de trabalho no serviço de urgência geral. Conclusão: A utilização de escalas de alerta precoce é fundamental na medida em que uniformiza a avaliação da pessoa em função do risco de deterioração orgânica com recurso a uma linguagem comum. Tal possibilita a deteção precoce de uma alteração no seu estado, permitindo uma intervenção antecipada e prevenindo complicações Background: Nurses play a fundamental role in the surveillance and monitoring of the critically ill patient and consequently, in the screening for complications that might compromise their health and delay recovery. Physiological changes that reflect organic deterioration allow an early detection of critically ill patients. In this sense, early warning scales were developed, with the National Early Warning Score being an example thereof. Objective: To standardise the assessment of critically ill patient hospitalised in the emergency room. Methodology: Intervention project based on the project methodology. Results: Data collection was carried out at three different times, and after its analysis we found that in all of them more than 50% of the people were not properly allocated. In the first instance of data collection, the result was 52%, in the second 57.1% and in the third 75%. The implementation of National Early Warning Score was not made possible due to the high workload in the emergency room. Conclusion: The use of early warning scales is beneficial in that it standardises the person's assessment using a common language. This allows an early detection of a change in their condition, which prevents further complications. info:eu-repo/semantics/publishedVersion

National Early Warning Score (NEWS) är ett bedömningsinstrument som används inom vården för att upptäcka och varna när en patient blir kraftigt försämrad. Syftet med litteraturöversikten var att sammanställa kunskap om sjuksköterskors erfarenheter av att använda bedömningsinstrumentet NEWS. En integrerad litteraturöversikt genomfördes där 12 vetenskapliga artiklar togs ut efter en systematisk litteratursökning i PubMed och CINAHL. Av dessa var det sex med kvalitativ metod, fyra kvantitativ metod och två mixad metod, som granskades och analyserades. Analysen resulterade i fyra kategorier. Dessa var ”NEWS användes av sjuksköterskan för att observera, bedöma och planera vård”, ”NEWS kunde både vara ett stöd och skapa merarbete”, ”NEWS förbättrade kommunikationen med andra kollegor” och ” NEWS kunde främja sjuksköterskan i sin profession”. Slutsatserna som drogs var att sjuksköterskorna ansåg NEWS som användbart vid att uppfatta en patients försämring, instrumentet användes även som ett sätt att stödja en egen klinisk bedömning. Sjuksköterskorna ansåg att NEWS behövde anpassas för olika sjukdomstillstånd eftersom falska höga värden ledde till onödiga kontroller och larmutmattning. Kommunikationen mellan kollegor blev bättre och sjuksköterskorna fick stöd och bättre respons när vitalparametrar kommunicerades. Sjuksköterskorna ansåg att NEWS ökade fokuset på vitalparametrar vilket ledde till ökad kunskap om avvikelser samt stimulerade till egna bedömningar. Författarna anser att det finns behov av att arbeta särskilt med kommunikationsmetoder som införlivas med NEWS, där alla parter i vårdkedjan förstår instrumentets relevans. Detta kan förslagsvis göras i samband vid implementering av NEWS med tydliga riktlinjer kring bedömnings-instrumentet, hur det ska användas och varför.

Supplemental Digital Content is available in the text, Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings. This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria. A single-center retrospective cohort study From April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in Japan We collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed. Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P

ObjectivesIn the English National Health Service, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient’s risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS).DesignLogistic regression model development and external validation study.SettingTwo acute hospitals (YH—York Hospital for model development; NH—Northern Lincolnshire and Goole Hospital for external model validation).ParticipantsAdult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2).ResultsThe risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups.ConclusionsAn externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.

Background the National Early Warning Score (NEWS) is a tool based on vital signs that aims to standardise detection of, and response to, clinical deterioration in adults. NEWS has been adopted in hospitals but not adapted for other settings. This study aimed to explore the feasibility of measuring the NEWS in care homes and describe the distribution of NEWS readings amongst care home residents. Methods descriptive analysis of all NEWS readings recorded in a 30-month period (2016–19) across 46 care homes in one Clinical Commissioning Group in England. Comparisons were made between measurements taken as a routine reading and those prompted by concern about acute illness. Results a total of 19,604 NEWS were recorded from 2,424 older adults (≥65 years; mean age 85). Median NEWS was 2. Two thirds (66%) of residents had a low NEWS (≤2), and 28% had a score of 0. Of the total NEWS readings, 6,277 (32%) were known to be routine readings and 2,256 (12%) were measured because of staff concerns. Median NEWS was 1 for routine and 2 for concern recordings. Overall, only 12% of NEWS were high (≥5), but a higher proportion were elevated when there were concerns about acute illness (18%), compared with routine recordings (7%). Conclusions use of NEWS in care homes appears to be feasible. The majority of NEWS were not elevated, and the distribution of scores is consistent with other out-of-hospital settings. Further work is required to know if NEWS is triggering the most appropriate response and improving care home resident outcomes.

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

Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

National Early Warning Score (NEWS) er et observasjonsverktøy som består av 6 fysiologiske parametere med referanseverdi. NEWS benyttes på en strukturert måte for å identifisere tidlige tegn på sykdom eller forverringer i helsetilstand. Ved utregning av NEWS gis det en total score. Ved økt NEWS-score følger en veiledning for ny vurdering eller anbefaling om kontakt med annet helsepersonell. NEWS implementeres i primærhelsetjenesten i forbindelse med pasientsikkerhetskampanjen ”Tidlig oppdagelse i forverret tilstand”. Hensikten med denne studien er å utforske hvilke erfaringer sykepleiere i primærhelsetjenesten har ved bruk av NEWS. Studien har et kvalitativ utforskende design med en fenomelogisk tilnærming. Det ble gjennomført 6 semi-strukturerte intervju av 3 sykepleiere fra institusjon og 3 sykepleiere fra hjemmetjeneste i primærhelsetjenesten i Vestfold. Teorigrunnlaget er lagt på bakgrunn av relevante nasjonale og internasjonale studier, faglitteratur og stortingsmeldinger. Samhandlingsreformen har ført til en forskyvning av oppgaver fra spesialisthelsetjenesten til primærhelsetjenesten med et økt ansvar for befolkningens helsetilbud. Med økende andel pasienter med mer sammensatte og komplekst sykdomsbilde med økt tjenestebehov vil en konsekvens være et større behov for sykepleiere med klinisk kompetanse. NEWS kan bidra til at sykepleierne har et verktøy som bidrar til økt observasjonskompetanse og til å følge opp pasientenes helsetilstand. Resultat : Hovedfunn viser til at NEWS bidrar til en økt trygghet og styrker sykepleierne i beslutningsprosesser. NEWS kan ikke benyttes alene som en sjekkliste, men vurderes sammen med pasientens klinikk og helsehistorie til en helhet. NEWS bidrar til at sykepleierne opplever at de har fått en økt påvirkningskraft når de kommuniserer med annet helsepersonell. Ved bruk av NEWS opplever sykepleierne at de er i forkant fordi de oppdager endringer før de fremtrer klinisk. Ved høy NEWS-score kan det se ut til at sykepleierne legger mest vekt på pasientens tilstand når de skal ta vurdering om lege må tilkalles. NEWS kan også benyttes av andre faggrupper men at det er en forutsetning at NEWS blir forstått for å ha verdi. Funn tilsier at det er behov for at primærhelsetjenesten styrkes gjennom økt fokus på akuttkompetanse og at det er behov for sykepleiere med erfaring og kompetanse i å oppdage sykdom og forverrelser. Sykepleierne må tilbys opplæring og faglig oppdatering for å imøtekomme utfordringene hos pasienter med kompleks sykdomsbilde. Studiens funn synliggjør også at det er et behov for selvstendige sykepleiere med bred kompetanse, klinisk observasjonskompetanse, vurderings- og handlingskompetanse for å ivareta pasienter med langvarige, kroniske sykdommer. Det viste seg at det er utfordringer i forhold til ansatte uten formell utdannelse og nivå på utdanning og kompetanse. Det er imidlertid utfordrende for sykepleierne å benytte NEWS på bakgrunn av at det er en pågående implementeringsarbeid i primærhelsetjenesten. Konklusjon : Sykepleierne er positive til å benytte NEWS i primærhelsetjenesten. Å anvende NEWS gir sykepleierne økt bevissthet i å strukturere kliniske observasjonene. De opplevde større trygghet på egen kompetanse. Samtidig erfarte de at de kan ta raskere vurderinger og beslutninger og kommunisere tydeligere. Sykepleierne i denne studien legger vekt på at det er pasientens klinikk og den kliniske vurderingen som veier tyngst og at NEWS må benyttes som veiledning. NEWS er et egnet verktøy for å oppdage tegn på sykdom og forverrelser tidlig, men det forutsetter at utføreren har kunnskap og kompetanse til å forstå NEWS opp mot pasientens klinikk eller helsetilstand. Sykepleierne er usikre på om NEWS kan delegeres til annet helsepersonell. Det kommer frem i studien at alle sykepleierne ønsker å følge opp pasientene systematisk med NEWS, ved sykdom eller forverrelser av kroniske sykdommer og lidelser

ObjectivesThere are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions.DesignLogistic regression model development and external validation study.SettingTwo acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data).ParticipantsAdult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission.ResultsThe risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00).ConclusionsWe have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

The aim of this study was to evaluate the value of the Abbreviated National Early Warning Score (aNEWS) for predicting admissions and in-hospital mortality in elderly patients present to Emergency Department (ED). This retrospective, single-centred observational study was carried out in the ED of Minamitama Hospital, in Tokyo, Japan from 1 April 2018 to 30 April 2018. All of the patients aged 65 and older were included in this study. The aNEWS is based on six common physiological vital signs, including peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate, and the Alert, responds to Voice, responds to Pain, Unresponsive score. The scores range from 0 and 3 for each parameter. The aNEWS ranged from a score of 0 to a maximum of 17. The receiver operating characteristics (ROC) analysis was used to evaluate the predictive value of the aNEWS for admission and in-hospital mortality. The median aNEWS of patients admitted to the hospital was significantly higher than that of patients discharged from the ED (P

Introduction: Une identification et une intervention précoce constituent des éléments importants dans la prise en charge du sepsis. L'objectif principal de notre étude est de tester si la mise à disposition du National Early Warning Score (NEWS) permet une meilleure qualité du triage des patients consultant aux urgences pour infection.Méthodes : Étude multicentrique randomisée, basée sur le triage du patient septique, par l’infirmier d’accueil, à travers cinq vignettes cliniques. Le niveau de triage établi par un comité d’experts était le gold standard. Les participants étaient randomisés en deux groupes de triage, un groupe NEWS et un groupe contrôle. Le critère de jugement principal est la concordance du triage par les participants comparativement au gold standard.Résultats : Le classement par le groupe NEWS est meilleur que celui du groupe contrôle (43% vs 29%, p=0,015). L’apport du NEWS est différent selon les cas (p=0,019). Le triage est meilleur chez les participants formés à la prise en charge du sepsis (48% vs 31%, p=0,012). L'aptitude à repérer le patient grave est meilleure dans le groupe NEWS, en particulier la vignette 1 (Se : 86,7% vs 43,3% ; pConclusion : L’utilisation du NEWS permet d’améliorer la qualité du triage en termes de pertinence et d’homogénéité sur des vignettes cliniques soumises aux infirmiers d’accueil.

Background/aim: Early warning scores (EWS), widely used around the world but not yet in Turkey, are composed of physiological parameters designed to determine potentially worsening patients to perform necessary interventions in time. The aim is to determine the national EWS (NEWS) of the patients to assess the relation between this score and length of hospital stay (LOHS), transfer to the ICU, 24-h and 28-day mortality rates, and the frequency of in-hospital cardiac arrest (IHCA). Materials and methods: NEWS of all the patients in the internal medicine clinics were calculated via a point prevalence study. The LOHS, transfer to the ICU, rates of mortality in the 24-h and 28-day period, IHCA rate, and the period of the stay in the ICU parameters were determined. Results: Out of 104 patients, 84 of them had low scores (