Abstract
Background
Decompensation on the medical floor is associated with increased in-hospital mortality.
Objective
Our aim was to determine the accuracy of the National Early Warning Score (NEWS) in
predicting early, unplanned escalation of care in patients admitted to the hospital
from the emergency department (ED) compared to the Shock Index (SI) and the quick
Sepsis-Related Organ Failure Assessment (qSOFA) score.
Methods
We conducted a retrospective cohort study of patients admitted directly from the ED
to monitored or unmonitored beds (November 9, 2015 to April 30, 2018) in 3 hospitals.
Interhospital transfers were excluded. Patient data, vital status, and bed assignment
were extracted from the electronic medical record. Scores were calculated using the
last set of vital signs prior to leaving the ED. Primary endpoint was in-hospital
death or placement in an intermediate or intensive care unit within 24 h of admission
from the ED. Scores were compared using the area under the receiver operating curve
(AUROC).
Results
Of 46,018 ED admissions during the study window, 39,491 (85.8%) had complete data,
of which 3.7% underwent escalation in level of care within 24 h of admission. NEWS
outperformed (AUROC 0.69; 95% confidence interval [CI] 0.68–0.69) qSOFA (AUROC 0.63;
95% CI 0.62–0.63; p < 0.001) and SI (AUROC 0.60; 95% CI 0.60–0.61; p < 0.001) at predicting unplanned escalations or death at 24 h.
Conclusions
This multicenter study found NEWS was superior to the qSOFA score and SI in predicting
early, unplanned escalation of care for ED patients admitted to a general medical-surgical
floor.
Keywords
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Article info
Publication history
Published online: May 03, 2020
Accepted:
March 18,
2020
Received in revised form:
March 4,
2020
Received:
November 26,
2019
Identification
Copyright
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