Tracking the National Early Warning Score 2 from Prehospital Care to the Emergency Department: A Prospective, Ambulance-Based, Observational Study

• Autores: Martín Rodríguez, Francisco; Sanz García, Ancor; Ortega, Guillermo José; Delgado Benito, Juan F.; Aparicio Obregon, Silvia; Martínez Fernández, Francisco T.; González Crespo, Pilar; Otero de la Torre, Santiago; Castro Villamor, Miguel A.; López Izquierdo, Raúl
• Año de publicación: 2021
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Clinical skills; Early warning score; In-hospital mortality
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Aim of the study: To assess the prognostic ability of the National Early Warning Score 2 (NEWS2) at three time points of care -at the emergency scene (NEWS2-1), just before starting the transfer by ambulance to the hospital (NEWS2- 2), and at the hospital triage box (NEWS2-3)- to estimate in-hospital mortality after two days since the index event. Methods: Prospective, multicenter, ambulance-based, cohort ongoing study in adults (>18 years) consecutively attended by advanced life support (ALS) and evacuated with high-priority to the emergency departments (ED) between October 2018 and May 2021. Vital sign measures were used to calculate the NEWS2 score at each time point, then this score was entered in a logistic regression model as the single predictor. Two outcomes were considered: first, all-cause mortality of the patients within 2 days of presentation to EMS, and second, unplanned ICU admission. The calibration and scores comparison was performed by representing the predicted vs the observed risk curves according to NEWS score value. Results: 4943 patients were enrolled. Median age was 69 years (interquartile range 53- 81). The NEWS2-3 presented the better performance for all-cause two-day in-hospital mortality with an AUC of 0.941 (95% CI: 0.917-0.964), showing statistical differences with both the NEWS2-1 (0.872 (95% CI: 0.833-0.911); p < 0.003) and with the NEWS2- 2 (0.895 (95% CI: 0.866-0.925; p < 0.05). The calibration and scores comparison results showed that the NEWS2-3 was the best predictive score followed by the NEWS2-2 and the NEWS2-1, respectively. Conclusions: The NEWS2 has an excellent predictive performance. The score showed a very consistent response over time with the difference between “at the emergency scene” and “pre-evacuation” presenting the sharpest change with decreased threshold values, thus displaying a drop in the risk of acute clinical impairment.
Fil: Martín Rodríguez, Francisco. Universidad de Valladolid; España
Fil: Sanz García, Ancor. No especifíca;
Fil: Ortega, Guillermo José. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Delgado Benito, Juan F.. Universidad de Valladolid; España
Fil: Aparicio Obregon, Silvia. Universidad Industrial Santander; Colombia
Fil: Martínez Fernández, Francisco T.. Universidad de Valladolid; España
Fil: González Crespo, Pilar. No especifíca;
Fil: Otero de la Torre, Santiago. No especifíca;
Fil: Castro Villamor, Miguel A.. Universidad de Valladolid; España
Fil: López Izquierdo, Raúl. Hospital Universitario Rio Hortega de Valladolid; España