A single-centre observational cohort study of admission National Early Warning Score (NEWS).
BACKGROUND
Early warning scores are commonly used in hospitals to identify patients at risk of deterioration. The National Early Warning Score (NEWS) has recently been introduced to UK practice. However, it is not yet widely implemented. We aimed to compare NEWS to the early warning score currently used in our hospital--the Patient at Risk Score (PARS).


METHODS
We conducted a prospective observational cohort study of all adult general medical patients admitted to a single hospital over a 20-day period. Physiological data and early warning scores recorded in bedside charts were collected on admission and a NEWS score was retrospectively calculated. The patient notes were reviewed at 48 h after admission. The primary outcome was a composite of critical care admission or death within 2 days of admission. The secondary outcome was hospital length of stay.


RESULTS
NEWS was more strongly associated with the primary outcome than PARS (odds ratio 1.54, p < 0.001 compared to 1.42, p = 0.056). A NEWS of 3 or more was associated with the primary outcome (odds ratio 7.03, p = 0.003). Neither score was correlated with hospital length of stay.


CONCLUSIONS
NEWS on admission is superior to PARS for identifying patients at risk of death or critical care admission within the first 2 days of hospital stay. Current guidelines advocate a threshold of 5 for triggering a clinical review. However, since a score of 3 or more was associated with a poor outcome, this recommendation should be reviewed. Both scores were poor predictors of hospital length of stay.
Queen Mary University of London, EC1M 6BQ, UK. Electronic address: t.abbott@qmul.ac.uk.
Tom E F
TE
Abbott
Consultant in Acute Medicine, Northwick Park Hospital, Harrow HA1 1UJ, UK.
Nidhi
N
Vaid
Consultant in Acute Medicine, Whittington Health, N19 5NF, UK.
Dorothy
D
Ip
London School of Economics, London WC2A 2AE, UK.
Nicholas
N
Cron
Specialist Trainee in Haematology, Cheltenham General Hospital, GL53 7AN, UK.
Matt
M
Wells
Queen Mary University of London, EC1M 6BQ, UK.
Hew D T
HD
Torrance
Queen Mary University of London, EC1M 6BQ, UK; Consultant in Acute and Metabolic Medicine, Barts Health NHS Trust, E1 1BB, UK.
Julian
J
Emmanuel
D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D011787:Quality of Health Care; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors
Clinical outcomes; Early warning score; Monitoring; Physiological parameters