Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration?
Shaw, Joanna Clark, Sophie Moore, Fionna
Shaw, Joanna
Clark, Sophie
Moore, Fionna
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Abstract
Introduction The National Early Warning Score (NEWS)
aids the early recognition of those at risk of becoming
critically ill. NEWS has been recommended for use
by ambulance services, but very little work has been
undertaken to date to determine its suitability. This paper
examines whether a prehospital NEWS derived from
ambulance service clinical observations is associated
with the hospital ED disposition.
Methods Prehospital NEWS was retrospectively
calculated from the ambulance service clinical records
of 287 patients who were treated by the ambulance
service and transported to hospital. In this cohort study,
derived NEWS scores were compared with ED disposition
data and patients were categorised into the following
groups depending on their outcome: discharged from ED,
admitted to a ward, admitted to intensive therapy unit
(ITU) or died.
Results Prehospital NEWS-based ambulance service
clinical observations were significantly associated with
discharge disposition groups (p<0.001), with scores
escalating in line with increasing severity of outcome.
Patients who died or were admitted to ITU had higher
scores than those admitted to a ward or discharged
from ED (mean NEWS 7.2 and 7.5 vs 2.6 and 1.7,
respectively), and in turn those who were admitted to
a ward had higher pre-hospital NEWS than those who
were discharged (2.6 vs 1.7).
Conclusion Our findings suggest that the NEWS could
successfully be used by ambulance services to identify
patients most at risk from subsequent deterioration.
The implementation of this early warning system has
the potential to support ambulance clinician decision
making, providing an additional tool to identify and
appropriately escalate care for acutely unwell patients
https://emj.bmj.com/content/emermed/34/8/533.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2016-206115