title: Predictive value of the National Early Warning Score-Lactate for mortality and the need for critical care among general emergency department patients.
abstract: What is the predictive value of the National Early Warning Score-Lactate (NEWS-L) score for mortality and the need for critical care in general emergency department (ED) patients?
  
  
  
  In this retrospective cohort study, we enrolled all adult patients who visited the ED of an urban academic tertiary-care university hospital in South Korea over 2 consecutive months. The primary outcome was 2-day mortality. The secondary outcomes were the need for critical care (advanced airway use, vasopressor or inotropic agent use, intensive care unit admission) during an ED stay; 2-day composite outcome (2-day mortality and the need for critical care); 7-day mortality; and in-hospital mortality.
  
  
  
  During the study period, 4624 adult patients visited the ED. Of these, 87 (1.9%) died within 2 days. In total, 481 patients (10.4%) required critical care during their ED stay. The 2-day composite outcome, 7-day mortality, and in-hospital mortality were 10.9% (503/4624), 2.5% (116/4624), and 3.9% (182/4624), respectively. The NEWS-L demonstrated excellent predictive value for 2-day mortality with an area under the receiver operating characteristic curve (AUROC) of 0.96 (95% confidence interval [CI], 0.94-0.98); this value was better than that of the NEWS alone (AUROC 0.94 [95% CI, 0.91-0.96], P=.002). The AUROC of the NEWS-L for the need for critical care was 0.83 (95% CI, 0.81-0.85); for the 2-day composite outcome, it was 0.84 (95% CI, 0.82-0.86); for 7-day mortality, it was 0.94 (95% CI, 0.92-0.96); and for in-hospital mortality, it was 0.87 (95% CI, 0.85-0.90). Logistic regression results confirmed that the ratio of the NEWS to the initial lactate level was 1:1. Similar results were obtained in the subgroup analyses (disease-infection, disease-vascular and heart, disease-others, and nondisease). The high-risk NEWS-L group (NEWS-L≥7, 9.4% of all patients) had an adjusted odds ratio of 28.67 (12.66-64.92) for 2-day mortality in the logistic regression model adjusted for basic characteristics.
  
  
  
  The NEWS-L can provide excellent discriminant value for predicting 2-day mortality in general ED patients, and it has the best discriminant value regarding the need for critical care and composite outcomes. The NEWS-L may be helpful in the early identification of at-risk general ED patients.
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907.
authors.forename: Sion
authors.initials: S
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907. Electronic address: jcyoon75@jbnu.ac.kr.
authors.forename: Jaechol
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907.
authors.forename: Jae Baek
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907.
authors.forename: Youngho
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907.
authors.forename: Taeoh
authors.initials: T
authors.lastname: Jeong
authors.affiliation: National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Kyunggi-do 10408.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001794:Blood Pressure; D001831:Body Temperature; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003243:Consciousness; D003422:Critical Care / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea; D056152:Respiratory Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D019344:Lactic Acid
keywords: Critical care; ED; Mortality; NEWS; NEWS-L