title: Utility of a single early warning score in patients with sepsis in the emergency department.
abstract: BACKGROUND
  An important element in improving the care of patients with sepsis is early identification and early intervention. Early warning score (EWS) systems allow earlier identification of physiological deterioration. A standardised national EWS (NEWS) has been proposed for use across the National Health Service in the UK.
  
  
  OBJECTIVE
  To determine whether a single NEWS on emergency department (ED) arrival is a predictor of outcome, either in-hospital death within 30 days or intensive care unit (ICU) admission within 2 days, in patients with sepsis.
  
  
  METHODS
  Data were collected over a 3-month period as part of a national audit in 20 EDs in Scotland. All adult patients who were admitted for at least 2 days or who died within 2 days were screened for sepsis criteria. Patients with  systemic inflammatory response syndrome criteria were included. An EWS was calculated based on initial physiological observations made in the ED using the NEWS.
  
  
  RESULTS
  Complete data were available for 2003 patients. Each rise in NEWS category was associated with an increased risk of mortality when compared to the lowest category (5-6: OR 1.95, 95% CI 1.21 to 3.14), (7-8: OR 2.26, 95% CI 1.42 to 3.61), (9-20: OR 5.64, 95% CI 3.70 to 8.60). This was also the case for the combined outcome (ICU and/or mortality).
  
  
  CONCLUSIONS
  An increased NEWS on arrival at ED is associated with higher odds of adverse outcome among patients with sepsis. The use of NEWS could facilitate patient pathways to ensure triage to a high acuity area of the ED and senior clinician involvement at an early stage.
authors.affiliation: Emergency Department, Royal Alexandra Hospital, Paisley, UK.
authors.forename: Alasdair R
authors.initials: AR
authors.lastname: Corfield
authors.affiliation: Information Services Division, National Services Scotland, Glasgow, Scotland, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lees
authors.affiliation: Radiology Department, Ninewells Hospital, Dundee, Scotland, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Zealley
authors.affiliation: Anaesthetic Department, Crosshouse Hospital, Kilmarnock, Scotland, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Houston
authors.affiliation: Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dickie
authors.affiliation: Information Services Division, National Services Scotland, Glasgow, Scotland, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Ward
authors.affiliation: Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland, UK.
authors.forename: Crawford
authors.initials: C
authors.lastname: McGuffie
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D012720:Severity of Illness Index; D013222:State Medicine; D055815:Young Adult
keywords: Death/Mortality; Emergency Department; Intensive Care; Resuscitation, Clinical Care; Triage