Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department.
BACKGROUND
Several triage systems have been developed for use in the emergency department (ED), however they are not designed to detect deterioration in patients. Deteriorating patients may be at risk of going undetected during their ED stay and are therefore vulnerable to develop serious adverse events (SAEs). The national early warning score (NEWS) has a good ability to discriminate ward patients at risk of SAEs. The utility of NEWS had not yet been studied in an ED.


OBJECTIVE
To explore the performance of the NEWS in an ED with regard to predicting adverse outcomes.


METHODS
A prospective observational study. Patients Eligible patients were those presenting to the ED during the 6 week study period with an Emergency Severity Index (ESI) of 2 and 3 not triaged to the resuscitation room.


METHODS
NEWS was documented at three time points: on arrival (T0), hour after arrival (T1) and at transfer to the general ward/ICU (T2). The outcomes of interest were: hospital admission, ICU admission, length of stay and 30 day mortality.


RESULTS
A total of 300 patients were assessed for eligibility. Complete data was able to be collected for 274 patients on arrival at the ED. NEWS was significantly correlated with patient outcomes, including 30 day mortality, hospital admission, and length of stay at all-time points.


CONCLUSIONS
The NEWS measured at different time points was a good predictor of patient outcomes and can be of additional value in the ED to longitudinally monitor patients throughout their stay in the ED and in the hospital.
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Section Acute Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. Electronic address: n.alam@vumc.nl.
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Alam
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
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Vegting
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
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Houben
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
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van Berkel
Northwest London Collaboration for Leadership in Applied Health Research and Care, Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, United Kingdom.
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Vaughan
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Section Acute Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
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Kramer
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Section Acute Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
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Nanayakkara
D000367:Age Factors; D000368:Aged; D016638:Critical Illness / Q000401:mortality; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010343:Patient Admission; D011446:Prospective Studies; D018570:Risk Assessment; D055986:Vital Signs
Clinical outcomes; Deteriorating patients; Early warning score; Monitoring; NEWS; Physiological parameters