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Doğan NÖ, Özturan İU, Pekdemir M, Yaka E, Yılmaz S. Prognostic value of early warning scores in patients presenting to the emergency department with exacerbation of COPD. Med Klin Intensivmed Notfmed 2024; 119:129-135. [PMID: 37401954 DOI: 10.1007/s00063-023-01036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/24/2023] [Accepted: 06/03/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a condition that frequently presents to the emergency department (ED) and its prognosis is not very well understood. Risk tools that can be used rapidly in the ED are needed to predict the prognosis of these patients. METHODS This study comprised a retrospective cohort of AECOPD patients presenting to a single center between 2015 and 2022. The prognostic accuracy of several clinical early warning scoring systems, Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), NEWS‑2, Systemic Inflammatory Response Syndrome (SIRS) and the quick Sepsis-related Organ Failure Assessment (qSOFA), were compared. The outcome variable was determined as one-month mortality. RESULTS Of the 598 patients, 63 (10.5%) had died within 1 month after presenting to the ED. Patients who died had more often congestive heart failure, altered mental status, and admission to intensive care, and they were older. Although the MEWS, NEWS, NEWS‑2, and qSOFA scores of those who died were higher than those who survived, there was no difference between the SIRS scores of these two groups. The score with the highest positive likelihood ratio for mortality estimation was qSOFA (8.5, 95% confidence interval [CI] 3.7-19.6). The negative likelihood ratios of the scores were similar, the NEWS score had a negative likelihood ratio of 0.4 (95% CI 0.2-0.8) with the highest negative predictive value of 96.0%. CONCLUSION In AECOPD patients, most of the early warning scores that are frequently used in the ED were found to have a moderate ability to exclude mortality and a low ability to predict mortality.
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Affiliation(s)
- Nurettin Özgür Doğan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey.
| | - İbrahim Ulaş Özturan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Pekdemir
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serkan Yılmaz
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
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Psirides A, Mohan C. Comparison of the Aotearoa New Zealand Early Warning Score and National Early Warning Score to predict adverse inpatient events in a vital sign dataset. Anaesthesia 2023; 78:1422. [PMID: 37401898 DOI: 10.1111/anae.16093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Affiliation(s)
- A Psirides
- Wellington Regional Hospital, Wellington, New Zealand
| | - C Mohan
- Beaumont Hospital, Dublin, Ireland
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Çelik B, Karaca B. Evaluation of prognostic scoring systems in patients hospitalized from the emergency department in a low-income region: northern Syria after internal turmoil as a different universe. Turk J Med Sci 2023; 53:382-395. [PMID: 36945949 PMCID: PMC10388059 DOI: 10.55730/1300-0144.5595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/13/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In low-income or underdeveloped countries with conflict and internal unrest, healthcare facilities and staff are limited. For these reasons, it is necessary to use the most straightforward scoring systems to ensure that health facilities and staff are used effectively and to expedite processes through early and effective interventions for patients. In this study, we evaluate and compare the scoring systems used to predict patient prognosis for Emergency Department (ED) patients in northern Syria, which is an area marred by conflict and internal unrest. METHODS In this study, patients hospitalized in the Afrin, Azez Vatan, Jarablus, Tel Abyad, Rasulayn, El Bab, and Çobanbey hospitals in northern Syria were investigated. Only patients that were hospitalized in the emergency departments of these hospitals, including wards and intensive care units, were included in the study. Patients that were hospitalized from 03/01/2021 to 08/31/2021, the study period, were prospectively analyzed. Vital signs, medical histories and demographic data of the patients were recorded by calculating National Early Warning Score 2 (NEWS2), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and HOTEL Score (hypotension, oxygen saturation, low temperature, electrocardiogram, loss of independence). Acceptance parameters and scores were analyzed using statistical methods and by comparing groups. RESULTS : All four scoring systems were found to be effective in predicting mortality regarding ROC curve analysis. However, the statistical significance of the RAPS was slightly stronger than that of the other scores and REMS had the highest sensitivity and specificity amongst the four systems, at 86.2% and 84.1%, respectively. Regarding the risk of hospitalization in the ICU (p < 0.05), the sensitivity values of the cut-off values offered by the scoring systems remained below 0.70 regarding ROC curve analysis. RAPS had the highest sensitivity (65.2%) of the four systems with a cut-off value of 1.5. DISCUSSION This study in northern Syria has shown that although RAPS had stronger statistical power, REMS had better sensitivity and specificity for the prediction of mortality. Additionally, RAPS had better sensitivity for ICU risk. This study will contribute to the evaluation of healthcare in similar regions and to cost-effective healthcare delivery by using scoring systems for ED patients' admission.
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Affiliation(s)
- Burak Çelik
- Department of Emergency, Kırşehir Training and Research Hospital, Kırşehir, Turkey
| | - Bahadır Karaca
- Department of Emergency, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
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Juniper M. NEWS2, patient safety and hypercapnic respiratory failure. Clin Med (Lond) 2022; 22:518-521. [PMID: 38589151 PMCID: PMC9761431 DOI: 10.7861/clinmed.2022-0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The National Early Warning Score (NEWS) has been widely adopted for use in clinical practice in the UK since its introduction in 2012. It is designed to improve patient safety. The original score was adapted in 2017 to improve patient safety further by introducing a separate score for oxygen saturation to be used in selected patients with respiratory diseases. In this article, evidence for the effectiveness of the improved score is reviewed.
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Affiliation(s)
- Mark Juniper
- British Thoracic Society, London, UK and consultant respiratory physician, Great Western Hospital, Swindon, UK.
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Espinosa-Gonzalez A, Prociuk D, Fiorentino F, Ramtale C, Mi E, Mi E, Glampson B, Neves AL, Okusi C, Husain L, Macartney J, Brown M, Browne B, Warren C, Chowla R, Heaversedge J, Greenhalgh T, de Lusignan S, Mayer E, Delaney BC. Remote COVID-19 Assessment in Primary Care (RECAP) risk prediction tool: derivation and real-world validation studies. Lancet Digit Health 2022; 4:e646-e656. [PMID: 35909058 PMCID: PMC9333950 DOI: 10.1016/s2589-7500(22)00123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate assessment of COVID-19 severity in the community is essential for patient care and requires COVID-19-specific risk prediction scores adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms, and risk factors, we aimed to develop and validate two COVID-19-specific risk prediction scores. Remote COVID-19 Assessment in Primary Care-General Practice score (RECAP-GP; without peripheral oxygen saturation [SpO2]) and RECAP-oxygen saturation score (RECAP-O2; with SpO2). METHODS RECAP was a prospective cohort study that used multivariable logistic regression. Data on signs and symptoms (predictors) of disease were collected from community-based patients with suspected COVID-19 via primary care electronic health records and linked with secondary data on hospital admission (outcome) within 28 days of symptom onset. Data sources for RECAP-GP were Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC) primary care practices (development set), northwest London primary care practices (validation set), and the NHS COVID-19 Clinical Assessment Service (CCAS; validation set). The data source for RECAP-O2 was the Doctaly Assist platform (development set and validation set in subsequent sample). The two probabilistic risk prediction models were built by backwards elimination using the development sets and validated by application to the validation datasets. Estimated sample size per model, including the development and validation sets was 2880 people. FINDINGS Data were available from 8311 individuals. Observations, such as SpO2, were mostly missing in the northwest London, RCGP-RSC, and CCAS data; however, SpO2 was available for 1364 (70·0%) of 1948 patients who used Doctaly. In the final predictive models, RECAP-GP (n=1863) included sex (male and female), age (years), degree of breathlessness (three point scale), temperature symptoms (two point scale), and presence of hypertension (yes or no); the area under the curve was 0·80 (95% CI 0·76-0·85) and on validation the negative predictive value of a low risk designation was 99% (95% CI 98·1-99·2; 1435 of 1453). RECAP-O2 included age (years), degree of breathlessness (two point scale), fatigue (two point scale), and SpO2 at rest (as a percentage); the area under the curve was 0·84 (0·78-0·90) and on validation the negative predictive value of low risk designation was 99% (95% CI 98·9-99·7; 1176 of 1183). INTERPRETATION Both RECAP models are valid tools to assess COVID-19 patients in the community. RECAP-GP can be used initially, without need for observations, to identify patients who require monitoring. If the patient is monitored and SpO2 is available, RECAP-O2 is useful to assess the need for treatment escalation. FUNDING Community Jameel and the Imperial College President's Excellence Fund, the Economic and Social Research Council, UK Research and Innovation, and Health Data Research UK.
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Affiliation(s)
- Ana Espinosa-Gonzalez
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Denys Prociuk
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesca Fiorentino
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK; Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
| | - Christian Ramtale
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ella Mi
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emma Mi
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ben Glampson
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Cecilia Okusi
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Laiba Husain
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Jack Macartney
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Martina Brown
- South Central Ambulance Service NHS Trust, Otterboure, UK
| | - Ben Browne
- South Central Ambulance Service NHS Trust, Otterboure, UK
| | | | | | | | - Trisha Greenhalgh
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Erik Mayer
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Brendan C Delaney
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK.
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Loisa E, Kallonen A, Hoppu S, Tirkkonen J. Trends in the national early warning score are associated with subsequent mortality – A prospective three-centre observational study with 11,331 general ward patients. Resusc Plus 2022; 10:100251. [PMID: 35620180 PMCID: PMC9127395 DOI: 10.1016/j.resplu.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 10/25/2022] Open
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Loisa E, Kallonen A, Hoppu S, Tirkkonen J. Ability of the National Early Warning Score and its respiratory and haemodynamic subcomponents to predict short-term mortality on general wards: a prospective three-centre observational study in Finland. BMJ Open 2022; 12:e055752. [PMID: 35473725 PMCID: PMC9045111 DOI: 10.1136/bmjopen-2021-055752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To validate the ability of the National Early Warning Score (NEWS) to predict short-term mortality on hospital wards, with a special reference to the NEWS's respiratory and haemodynamic subcomponents. DESIGN A large, 1-year, prospective, observational three-centre study. First measured vital sign datasets on general wards were prospectively collected using a mobile solution system during routine patient care. Area under receiver operator characteristic curves were constructed, and comparisons between ROC curves were conducted with Delong's test for two correlated ROC curves. SETTING One university hospital and two regional hospitals in Finland. PARTICIPANTS All 19 001 adult patients admitted to 45 general wards in the three hospitals over the 1-year study period. After excluding 102/19 001 patients (0.53%) with data on some vital signs missing, the final cohort consisted of 18 889 patients with full datasets. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was 1-day mortality and secondary outcomes were 2-day and 30-day mortality rates. RESULTS Patients' median age was 70 years, 51% were male and 31% had a surgical reason for admission. The 1-day mortality was 0.36% and the 30-day mortality was 3.9%. The NEWS discriminated 1-day non-survivors with excellent accuracy (AUROC 0.91, 95% CI 0.87 to 0.95) and 30-day mortality with acceptable accuracy (0.75, 95% CI 0.73 to 0.77). The NEWS's respiratory rate component discriminated 1-day non-survivors better (0.78, 95% CI 0.72 to 0.84) as compared with the oxygen saturation (0.66, 95% CI 0.59 to 0.73), systolic blood pressure (0.65, 95% CI 0.59 to 0.72) and heart rate (0.67, 95% CI 0.61 to 0.74) subcomponents (p<0.01 in all ROC comparisons). As with the total NEWS, the discriminative performance of the individual score components decreased substantially for the 30-day mortality. CONCLUSIONS NEWS discriminated general ward patients at risk for acute death with excellent statistical accuracy. The respiratory rate component is especially strongly associated with short-term mortality. TRIAL REGISTRATION NUMBER NCT04055350.
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Affiliation(s)
- Eetu Loisa
- Faculty of Medicine, Tampere University, Tampere, Finland
- Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Kallonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Centre for Prehospital Emergency Care, Tampere University Hospital, Tampere, Finland
| | - Joonas Tirkkonen
- Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland
- Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland
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Stone PW, Minelli C, Feary J, Roberts CM, Quint JK, Hurst JR. “NEWS2” as an Objective Assessment of Hospitalised COPD Exacerbation Severity. Int J Chron Obstruct Pulmon Dis 2022; 17:763-772. [PMID: 35431544 PMCID: PMC9005866 DOI: 10.2147/copd.s359123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/12/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction There is currently no accepted way to risk-stratify hospitalised exacerbations of chronic obstructive pulmonary disease (COPD). We hypothesised that the revised UK National Early Warning Score (NEWS2) calculated at admission would predict inpatient mortality, need for non-invasive ventilation (NIV) and length-of-stay. Methods We included data from 52,284 admissions for exacerbation of COPD. Data were divided into development and validation cohorts. Logistic regression was used to examine relationships between admission NEWS2 and outcome measures. Predictive ability of NEWS2 was assessed using area under receiver operating characteristic curves (AUC). We assessed the benefit of including other baseline data in the prediction models and assessed whether these variables themselves predicted admission NEWS2. Results 53% of admissions had low risk, 24% medium risk and 23% a high risk NEWS2 in the development cohort. The proportions dying as an inpatient were 2.2%, 3.6% and 6.5% by NEWS2 risk category, respectively. The proportions needing NIV were 4.4%, 9.2% and 18.0%, respectively. NEWS2 was poorly predictive of length-of-stay (AUC: 0.59[0.57–0.61]). In the external validation cohort, the AUC (95% CI) for NEWS2 to predict inpatient death and need for NIV were 0.72 (0.68–0.77) and 0.70 (0.67–0.73). Inclusion of patient demographic factors, co-morbidity and COPD severity improved model performance. However, only 1.34% of the variation in admission NEWS2 was explained by these baseline variables. Conclusion The generic NEWS2 risk assessment tool, readily calculated from simple physiological data, predicts inpatient mortality and need for NIV (but not length-of-stay) at exacerbations of COPD. NEWS2 therefore provides a classification of hospitalised COPD exacerbation severity.
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Affiliation(s)
- Philip W Stone
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, UK
| | - C Michael Roberts
- National Asthma and COPD Audit Programme, Royal College of Physicians of London, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
- National Asthma and COPD Audit Programme, Royal College of Physicians of London, London, UK
| | - John R Hurst
- National Asthma and COPD Audit Programme, Royal College of Physicians of London, London, UK
- UCL Respiratory, University College London, London, UK
- Correspondence: John R Hurst, UCL Respiratory, University College London, London, UK, Email
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Holland M, Kellett J. A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows. Eur J Intern Med 2022; 98:15-26. [PMID: 34980504 DOI: 10.1016/j.ejim.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although early warning scores were intended to simply identify patients in need of life-saving interventions, prediction has become their commonest metric. This review examined variation in the ability of the National Early Warning Scores (NEWS) in adult patients to predict absolute mortality at different times and cut-offs values. METHOD Following PRISMA guidelines, all studies reporting NEWS and NEWS2 providing enough information to fulfil the review's aims were included. RESULTS From 121 papers identified, the average area under the Receiver Operating Characteristic curve (AUC) for mortality declined from 0.90 at 24-hours to 0.76 at 30-days. Studies with a low overall mortality had a higher AUC for 24-hour mortality, as did general ward patients compared to patients seen earlier in their treatment. 24-hour mortality increased from 1.8% for a NEWS ≥3 to 7.8% for NEWS ≥7. Although 24-hour mortality for NEWS <3 was only 0.07% these deaths accounted for 9% of all deaths within 24-hours; for NEWS <7 24-hour mortality was 0.23%, which accounted for 44% of all 24-hour deaths. Within 30-days of a NEWS recording 22% of all deaths occurred in patients with a NEWS <3, 52% in patients with a NEWS <5, and 75% in patient with a NEWS <7. CONCLUSION NEWS reliably identifies patients most and least likely to die within 24-hours, which is what it was designed to do. However, many patients identified to have a low risk of imminent death die within 30-days. NEWS mortality predictions beyond 24-hours are unreliable.
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Affiliation(s)
- Mark Holland
- School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, Bolton University, Bolton, UK
| | - John Kellett
- Department of Emergency Medicine, Hospital of South-West Jutland, Esbjerg, Denmark.
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Ibrahim ZM, Bean D, Searle T, Qian L, Wu H, Shek A, Kraljevic Z, Galloway J, Norton S, Teo JT, Dobson RJB. A Knowledge Distillation Ensemble Framework for Predicting Short- and Long-Term Hospitalization Outcomes From Electronic Health Records Data. IEEE J Biomed Health Inform 2022; 26:423-435. [PMID: 34129509 DOI: 10.1109/jbhi.2021.3089287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The ability to perform accurate prognosis is crucial for proactive clinical decision making, informed resource management and personalised care. Existing outcome prediction models suffer from a low recall of infrequent positive outcomes. We present a highly-scalable and robust machine learning framework to automatically predict adversity represented by mortality and ICU admission and readmission from time-series of vital signs and laboratory results obtained within the first 24 hours of hospital admission. The stacked ensemble platform comprises two components: a) an unsupervised LSTM Autoencoder that learns an optimal representation of the time-series, using it to differentiate the less frequent patterns which conclude with an adverse event from the majority patterns that do not, and b) a gradient boosting model, which relies on the constructed representation to refine prediction by incorporating static features. The model is used to assess a patient's risk of adversity and provides visual justifications of its prediction. Results of three case studies show that the model outperforms existing platforms in ICU and general ward settings, achieving average Precision-Recall Areas Under the Curve (PR-AUCs) of 0.891 (95% CI: 0.878-0.939) for mortality and 0.908 (95% CI: 0.870-0.935) in predicting ICU admission and readmission.
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Affiliation(s)
- Zina M. Ibrahim
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
| | - Daniel Bean
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
| | - Thomas Searle
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
| | - Linglong Qian
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
| | - Honghan Wu
- Institute of Health Inforamtics, University College London, London, U.K
| | - Anthony Shek
- Department of Clinical Neuroscience, King's College London, London, U.K
| | - Zeljko Kraljevic
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, U.K
| | - Sam Norton
- Department of Psychology and the Department of Inflammation Biology, King's College London, London, U.K
| | - James T Teo
- NHS Foundation Trust, King's College Hospital, London, U.K
| | - Richard JB Dobson
- Department of Biostatistics and Health Informatics, King's College London, London, U.K
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O'Neill SM, Bell M, Casey A, Leen B, Clyne B, Tyner B, Smith SM, Watkinson PJ, O'Neill M, Ryan M. COMMENTARY: Is a Change from the National Early Warning System (NEWS) Warranted in Patients with Chronic Respiratory Conditions? COPD 2021; 18:129-132. [PMID: 33682525 DOI: 10.1080/15412555.2021.1892051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sinéad M O'Neill
- The Health Technology Assessment Directorate, The Health Information and Quality Authority (HIQA), Mahon, Cork, Ireland
| | - Miriam Bell
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Dublin, Ireland
| | - Avilene Casey
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Dublin, Ireland
| | - Brendan Leen
- National Health Library and Knowledge Service, Health Service Executive South, Kilkenny, Ireland
| | - Barbara Clyne
- The Health Technology Assessment Directorate, The Health Information and Quality Authority (HIQA), Mahon, Cork, Ireland.,HRB CICER and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barrie Tyner
- The Health Technology Assessment Directorate, The Health Information and Quality Authority (HIQA), Mahon, Cork, Ireland
| | - Susan M Smith
- HRB CICER and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Michelle O'Neill
- The Health Technology Assessment Directorate, The Health Information and Quality Authority (HIQA), Mahon, Cork, Ireland
| | - Máirín Ryan
- The Health Technology Assessment Directorate, The Health Information and Quality Authority (HIQA), Mahon, Cork, Ireland
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Martín-Rodríguez F, Sanz-García A, Medina-Lozano E, Castro Villamor MÁ, Carbajosa Rodríguez V, Del Pozo Vegas C, Fadrique Millán LN, Rabbione GO, Martín-Conty JL, López-Izquierdo R. The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study. PREHOSP EMERG CARE 2020; 25:597-606. [PMID: 32820947 DOI: 10.1080/10903127.2020.1813224] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54-81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.
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Martín-Rodríguez F, López-Izquierdo R, Del Pozo Vegas C, Sánchez-Soberón I, Delgado-Benito JF, Martín-Conty JL, Castro-Villamor MA. Can the prehospital National Early Warning Score 2 identify patients at risk of in-hospital early mortality? A prospective, multicenter cohort study. Heart Lung 2020; 49:585-591. [PMID: 32169257 DOI: 10.1016/j.hrtlng.2020.02.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The National Early Warning Score 2 (NEWS2) scores can help identify clinical deterioration. OBJECTIVE To assess the predictive capacity of the NEWS2 at prehospital level for the detection of early mortality in the hospital. METHODS Prospective multicenter cohort study, in which we compiled a database of observed vital signs between March 1, 2018 and May 30, 2019. We collected demographic data, vital signs (respiration rate, oxygen saturation, supplemental oxygen, temperature, systolic blood pressure, heart rate and level of consciousness), prehospital diagnosis and hospital mortality data. We calculated the AUROC of the NEWS2 for early mortality. RESULTS We included a total of 2335 participants. Median age was 69 years (IQR 54-81 years). The AUC for mortality within one day was 0.862 (95%CI:0.78-0.93), within two days 0.885 (95%CI:0.84-0.92) and within seven days 0.835 (95%CI:0.79-0.87) (in all cases, p<0.001). CONCLUSIONS The NEWS2 performed at prehospital level is a bedside tool for predicting early hospital mortality.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005 Valladolid, Spain; Advanced Medical Life Support, Emergency Medical Services (SACYL), P° Hospital Militar, 24, 47007 Valladolid, Spain.
| | - Raúl López-Izquierdo
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005 Valladolid, Spain; Emergency Department, Hospital Universitario Rio Hortega, C/ Dulzaina 2, 47012 Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Emergency Department, Hospital Clínico Universitario, Avda. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Irene Sánchez-Soberón
- Advanced Medical Life Support, Emergency Medical Services (SACYL), P° Hospital Militar, 24, 47007 Valladolid, Spain
| | - Juan F Delgado-Benito
- Advanced Medical Life Support, Emergency Medical Services (SACYL), P° Hospital Militar, 24, 47007 Valladolid, Spain
| | - José Luis Martín-Conty
- Faculty of Health Sciences, Castilla la Mancha University, Avda. Real Fábrica de Seda, s/n, 45600 Talavera de la Reina, Toledo, Spain
| | - Miguel A Castro-Villamor
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005 Valladolid, Spain
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Tan JW, Zhang XQ, Geng CM, Peng LL. Development of the National Early Warning Score-Calcium Model for Predicting Adverse Outcomes in Patients With Acute Pancreatitis. J Emerg Nurs 2020; 46:171-9. [PMID: 31866070 DOI: 10.1016/j.jen.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to develop a new model on the basis of the National Early Warning Score to predict intensive care unit admission and the mortality of patients with acute pancreatitis. METHODS Patients diagnosed with acute pancreatitis in the emergency department were enrolled. The values of the National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis in predicting intensive care unit admission and mortality of patients with acute pancreatitis were evaluated. RESULTS A total of 379 patients with acute pancreatitis were enrolled; 77 patients (20.3%) were admitted to the intensive care unit and 14 (3.7%) died. The National Early Warning Score and calcium level were identified as independent risk factors of intensive care unit admission. Serum calcium exhibited a moderate correlation with National Early Warning Score (r = -0.46; P < 0.001), Modified Early Warning Score (r = -0.37; P < 0.001), and Bedside Index of Severity in Acute Pancreatitis (r = -0.39; P < 0.001). A new model called National Early Warning Score-calcium was developed by combining National Early Warning Score and calcium blood test result, which had larger areas under the curve for predicting intensive care unit admission and mortality than the other 3 scoring systems. DISCUSSION A new model developed by combining National Early Warning Score and calcium exhibited better value in predicting the prognosis of acute pancreatitis than the models involving National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis alone.
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Mitchell E, Pearce MS, Roberts A. Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance. Br Med Bull 2019; 132:5-15. [PMID: 31815280 DOI: 10.1093/bmb/ldz033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND BACKGROUND Incidence of gram-negative bloodstream infections (GNBSIs) and sepsis are rising in the UK. Healthcare-associated risk factors have been identified that increase the risk of infection and associated mortality. Current research is focused on identifying high-risk patients and improving the methods used for surveillance. SOURCES OF DATA Comprehensive literature search of the topic area using PubMed (Medline). Government, professional and societal publications were also reviewed. AREAS OF AGREEMENT A range of healthcare-associated risk factors independently associate with the risk of GNBSIs and sepsis. AREAS OF CONTROVERSY There are calls to move away from using simple comorbidity scores to predict the risk of sepsis-associated mortality, instead more advanced multimorbidity models should be considered. GROWING POINTS AND AREAS FOR DEVELOPING RESEARCH Advanced risk models should be created and evaluated for their ability to predict sepsis-associated mortality. Investigations into the accuracy of NEWS2 to predict sepsis-associated mortality are required.
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Affiliation(s)
| | - Mark S Pearce
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Roberts
- Population Health Sciences Institute, Newcastle University, UK.,Academic Health Science Network - North East & North Cumbria.,South Tees Hospital Foundation Trust, UK.,North East Quality Observatory Service (NEQOS)
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Hope J, Griffiths P, Schmidt PE, Recio-Saucedo A, Smith GB. Impact of using data from electronic protocols in nursing performance management: A qualitative interview study. J Nurs Manag 2019; 27:1682-1690. [PMID: 31482604 PMCID: PMC6919414 DOI: 10.1111/jonm.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023]
Abstract
Aim To explore the impact of using electronic data in performance management to improve nursing compliance with a protocol. Background Electronic data are increasingly used to monitor protocol compliance but little is known about the impact on nurses’ practice in hospital wards. Method Seventeen acute hospital nursing staff participated in semi‐structured interviews about compliance with an early warning score (EWS) protocol delivered by a bedside electronic handheld device. Results Before electronic EWS data was used to monitor compliance, staff combined protocol‐led actions with clinical judgement. However, some observations were missed to reduce noise and disruption at night. After compliance monitoring was introduced, observations were sometimes covertly omitted using a loophole. Interviewees described a loss of autonomy but acknowledged the EWS system sometimes flagged unexpected patient deterioration. Conclusions Introducing automated electronic systems to support nursing tasks can decrease nursing burden but remove the ability to record legitimate reasons for missing observations. This can result in covert resistance that could reduce patient safety. Implications for nursing management Providing the ability to log legitimate reasons for missing observations would allow nurses to balance professional judgement with the use of electronic data in performance management of protocol compliance.
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Affiliation(s)
- Joanna Hope
- School of Health Sciences, National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC), University of Southampton, Wessex, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Paul E Schmidt
- Portsmouth Hospitals NHS Trust, Medical Assessment Unit, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Gary B Smith
- Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
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Suh ES, Sage B. COPD exacerbations: 2 much NEWS? Thorax 2019; 74:929-930. [PMID: 31506390 DOI: 10.1136/thoraxjnl-2019-213788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and Saint Thomas' NHS Foundation Trust, London, UK .,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Beth Sage
- Raigmore Hospital, NHS Highland, Inverness, UK.,Department of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Echevarria C, Steer J, Bourke SC. Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score. Thorax 2019; 74:941-946. [PMID: 31387892 PMCID: PMC6817986 DOI: 10.1136/thoraxjnl-2019-213470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
Background The National Early Warning Score 2 (NEWS2) includes two oxygen saturation scales; the second adjusts target saturations to 88%–92% for those with hypercapnic respiratory failure. Using this second scale in all patients with COPD exacerbation (‘NEWS2All COPD’) would simplify practice, but the impact on alert frequency and prognostic performance is unknown. Admission NEWS2 score has not been compared with DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) for inpatient mortality prediction. Methods NEWS, NEWS2 and NEWS2All COPD and DECAF were calculated at admission in 2645 patients with COPD exacerbation attending consecutively to one of six UK hospitals, all of whom met spirometry criteria for COPD. Alert frequency and appropriateness were assessed for all NEWS iterations. Prognostic performance was compared using the area under the receiver operating characteristic (AUROC) curve. Missing data were imputed using multiple imputation. Findings Compared with NEWS, NEWS2 reclassified 3.1% patients as not requiring review by a senior clinician (score≥5). NEWS2All COPD reduced alerts by 12.6%, or 16.1% if scoring for injudicious use of oxygen was exempted. Mortality was low in reclassified patients, with no patients dying the same day as being identified as low risk. NEWS2All COPD was a better prognostic score than NEWS (AUROC 0.72 vs 0.65, p<0.001), with similar performance to NEWS2 (AUROC 0.72 vs 0.70, p=0.090). DECAF was superior to all scores (validation cohort AUROC 0.82) and offered a more clinically useful range of risk stratification (DECAF=1.2%–25.5%; NEWS2=3.5%–15.4%). Conclusion NEWS2All COPD safely reduces the alert frequency compared with NEWS2. DECAF offers superior prognostic performance to guide clinical decision-making on admission, but does not replace repeated measures of NEWS2 during hospitalisation to detect the deteriorating patient.
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Affiliation(s)
- Carlos Echevarria
- Newcastle University, Newcastle upon Tyne, UK.,Respiratory Medicine, Royal Victoria Infimrary, Newcastle upon Tyne, UK
| | - John Steer
- Newcastle University, Newcastle upon Tyne, UK.,Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
| | - Stephen C Bourke
- Newcastle University, Newcastle upon Tyne, UK .,Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
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Abstract
Early Warning Scores (EWS) are a composite evaluation of a patient's basic physiology, changes of which are the first indicators of clinical decline and are used to prompt further patient assessment and when indicated intervention. These are sometimes referred to as "track and triggers systems" with tracking meant to denote periodic observation of physiology and trigger being a predetermined response criteria. This review article examines the most widely used EWS, with special attention paid to those used in military and trauma populations.The earliest EWS is the Modified Early Earning Score (MEWS). In MEWS, points are allocated to vital signs based on their degree of abnormality, and summed to yield an aggregate score. A score above a threshold would elicit a clinical response such as a rapid response team. Modified Early Earning Score was subsequently followed up with the United Kingdom's National Early Warning Score, the electronic cardiac arrest triage score, and the 10 Signs of Vitality score, among others.Severity of illness indicators have been in military and civilian trauma populations, such as the Revised Trauma Score, Injury Severity Score, and Trauma and Injury Severity. The sequential organ failure assessment score and its attenuated version quick sequential organ failure assessment were developed to aggressively identify patients near septic shock.Effective EWS have certain characteristics. First, they should accurately capture vital signs information. Second, almost all data should be derived electronically rather than manually. Third, the measurements should take into consideration multiple organ systems. Finally, information that goes into an EWS must be captured in a timely manner. Future trends include the use of machine learning to detect subtle changes in physiology and the inclusion of data from biomarkers. As EWS improve, they will be more broadly used in both military and civilian environments. LEVEL OF EVIDENCE: Review article, level I.
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Affiliation(s)
- Andrew A Kramer
- From the Prescient Healthcare Consulting, LLC (A.A.K.), Charlottesville, Virginia; Mercy Medical Center (F.S.), Redding, California; and Rutgers-Robert Wood Johnson Medical School (M.L.), New Brunswick, New Jersey
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Affiliation(s)
- Gary B Smith
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Oliver C Redfern
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marco Af Pimentel
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - James Malycha
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Paul E Schmidt
- Department of Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Pimentel MAF, Smith GB, Redfern OC, Gerry S, Collins GS, Malycha J, Prytherch D, Schmidt PE, Watkinson PJ. Reply to: NEWS2 needs to be tested in prospective trials involving patients with confirmed hypercapnia. Resuscitation 2019; 139:371-372. [PMID: 31005584 DOI: 10.1016/j.resuscitation.2019.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Marco A F Pimentel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Gary B Smith
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Oliver C Redfern
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - James Malycha
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, UK
| | - Paul E Schmidt
- Department of Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Mohammed MA, Faisal M, Richardson D, Scally A, Howes R, Beatson K, Irwin S, Speed K. The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals . Clin Med (Lond) 2019; 19:104-108. [PMID: 30872289 PMCID: PMC6454350 DOI: 10.7861/clinmedicine.19-2-104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. METHODS Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. RESULTS The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. CONCLUSIONS The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.
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Affiliation(s)
- Mohammed A Mohammed
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Midlands, UK and University of Bradford Faculty of Health Studies, Bradford, UK
| | - Muhammad Faisal
- University of Bradford Faculty of Health Studies, Bradford, UK
| | | | - Andy Scally
- School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Robin Howes
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Grimsby, UK
| | - Kevin Beatson
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Sally Irwin
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Kevin Speed
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Grimsby, UK
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Nicol E. The challenge of change: evidence, culture and expertise. Clin Med (Lond) 2018; 18:353. [PMID: 30287425 PMCID: PMC6334114 DOI: 10.7861/clinmedicine.18-5-353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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