title: The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death.
abstract: BACKGROUND
  Early warning scores (EWS) are recommended as part of the early recognition and response to patient deterioration. The Royal College of Physicians recommends the use of a National Early Warning Score (NEWS) for the routine clinical assessment of all adult patients.
  
  
  METHODS
  We tested the ability of NEWS to discriminate patients at risk of cardiac arrest, unanticipated intensive care unit (ICU) admission or death within 24h of a NEWS value and compared its performance to that of 33 other EWSs currently in use, using the area under the receiver-operating characteristic (AUROC) curve and a large vital signs database (n=198,755 observation sets) collected from 35,585 consecutive, completed acute medical admissions.
  
  
  RESULTS
  The AUROCs (95% CI) for NEWS for cardiac arrest, unanticipated ICU admission, death, and any of the outcomes, all within 24h, were 0.722 (0.685-0.759), 0.857 (0.847-0.868), 0.894 (0.887-0.902), and 0.873 (0.866-0.879), respectively. Similarly, the ranges of AUROCs (95% CI) for the other 33 EWSs were 0.611 (0.568-0.654) to 0.710 (0.675-0.745) (cardiac arrest); 0.570 (0.553-0.568) to 0.827 (0.814-0.840) (unanticipated ICU admission); 0.813 (0.802-0.824) to 0.858 (0.849-0.867) (death); and 0.736 (0.727-0.745) to 0.834 (0.826-0.842) (any outcome).
  
  
  CONCLUSIONS
  NEWS has a greater ability to discriminate patients at risk of the combined outcome of cardiac arrest, unanticipated ICU admission or death within 24h of a NEWS value than 33 other EWSs.
authors.affiliation: Centre of Postgraduate Medical Research & Education (CoPMRE), The School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, Dorset BH1 3LT, UK. gbsbusiness@virginmedia.com
authors.forename: Gary B
authors.initials: GB
authors.lastname: Smith
authors.forename: David R
authors.initials: DR
authors.lastname: Prytherch
authors.forename: Paul
authors.initials: P
authors.lastname: Meredith
authors.forename: Paul E
authors.initials: PE
authors.lastname: Schmidt
authors.forename: Peter I
authors.initials: PI
authors.lastname: Featherstone
mesh_terms: D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010343:Patient Admission; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D006113:United Kingdom; D055986:Vital Signs