1
|
Jouffroy R, Négrello F, Limery J, Gilbert B, Travers S, Bloch-Laine E, Ecollan P, Boularan J, Bounes V, Vivien B, Gueye P. The prehospital NEW score to assess septic shock in-hospital, 30-day and 90-day mortality. BMC Infect Dis 2024; 24:213. [PMID: 38365608 PMCID: PMC10873999 DOI: 10.1186/s12879-024-09104-7] [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: 09/21/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). METHODS Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports. RESULTS Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39-3.95], 2.08 [1.33-3.25] and 2.22 [1.38-3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively. CONCLUSION A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.
Collapse
Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital- Assistance Publique Hôpitaux Paris, 9 avenue Charles De Gaulle, 92100, Boulogne-Billancourt, Paris, France.
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, INSEP, Paris, France.
- INSERM U-1018, Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM, Paris Saclay University, Villejuif, France.
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France.
- UR5_3 PC2E, University of the Antilles, French West Indies, France.
| | - Florian Négrello
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
| | - Jean Limery
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
| | - Basile Gilbert
- Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France
| | | | - Emmanuel Bloch-Laine
- Emergency Department, Cochin Hospital, Paris, France
- Emergency Department, SMUR, Hôtel Dieu Hospital, Paris, France
| | - Patrick Ecollan
- Intensive Care Unit, SMUR, Pitie Salpêtriere Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Josiane Boularan
- Centre Hospitalier Intercommunal Castres-Mazamet, Castres, France
| | - Vincent Bounes
- Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, France
- UR5_3 PC2E, University of the Antilles, French West Indies, France
| |
Collapse
|
2
|
Li C, Wang K, Wu L, Song B, Tan J, Su H. Prehospital physiological parameters related illness severity scores can accurately discriminate the severe/critical state in adult patients with COVID-19. Ann Med 2023; 55:2239829. [PMID: 37489620 PMCID: PMC10392258 DOI: 10.1080/07853890.2023.2239829] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Whether the National Early Warning Score 2 (NEWS2) can effectively discriminate the severe/critical state of patients with coronavirus disease 2019 (COVID-19) at the prehospital stage remains unknown. We aimed to assess the performance of NEWS2 in rapidly discriminating severe/critical COVID-19 and its relationship with prehospital medical services. METHODS Six illness severity scores of 414 patients were calculated at the prehospital stage. Receiver operating characteristic curves were generated to explore the ability of these scores to discriminate severe/critical patients from mild/moderate patients. A logistic regression analysis was conducted to evaluate independent predictors associated with severe/critical state. RESULTS The age, numbers of comorbidities, prehospital care workload, consumption of medical human resources, and illness severity scores of severe/critical patients were higher than those of mild/moderate patients (p < 0.05). When NEWS2 scores >2, the sensitivity, specificity, positive predictive value, and negative predictive value were 93.5%, 90.7%, 74.1%, and 98.0%, respectively. The C-statistic of NEWS2 (0.963) was higher than that of quick Sequential Organ Failure Assessment (0.680, p < 0.001), CRB-65 (0.879, p < 0.001), Rapid Acute Physiology Score (0.692, p < 0.001), and Rapid Emergency Medicine Score (0.879, p < 0.001). NEWS2 was positively correlated with the numbers of prehospital treatment measures (r = 0.732, p < 0.001), numbers of medical staff (r = 0.615, p < 0.001), and total transport time (r = 0.595, p < 0.001). Age ≥65 years (OR = 5.43, p = 0.016), hypertension (OR = 5.39, p < 0.001), active malignancy (OR = 5.94, p = 0.005), and NEWS2 scores >2 (OR = 124.88, p < 0.001) were independent predictors to discriminate severe/critical patients. Oxygen saturation (SpO2) (OR =1.87, p < 0.001) was the unique independent predictor to discriminate false positive patients from true positive patients. CONCLUSIONS Prehospital NEWS2 can accurately and rapidly discriminate severe/critical COVID-19 during the Omicron variant wave. High levels of NEWS2 indicate an increase in prehospital care workload and consumption of medical human resources.
Collapse
Affiliation(s)
- Chen Li
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kaili Wang
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liang Wu
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bing Song
- Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junyuan Tan
- Medical Service Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haibin Su
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
3
|
Thorén A, Joelsson-Alm E, Spångfors M, Rawshani A, Kahan T, Engdahl J, Jonsson M, Djärv T. The predictive power of the National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team: A prospective multi-centre trial. Resusc Plus 2022; 9:100191. [PMID: 35005661 PMCID: PMC8718668 DOI: 10.1016/j.resplu.2021.100191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/13/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/23/2022] Open
Abstract
Aim Early identification of patients at risk of serious adverse events (SAEs) is of vital importance, yet it remains a challenging task. We investigated the predictive power of National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team (RRT). Methods Prospective, observational cohort study on 898 consecutive patients assessed by the RRTs in 26 Swedish hospitals. For each patient, NEWS and NEWS 2 scores were uniformly calculated by the study team. The associations of NEWS and NEWS 2 scores with unanticipated admissions to Intensive care unit (ICU), mortality and in-hospital cardiac arrests (IHCA) within 24 h, and the composite of these three events were investigated using logistic regression. The predictive power of NEWS and NEWS 2 was assessed using the area under the receiver operating characteristic (AUROC) curves. Results The prognostic accuracy of NEWS/NEWS 2 in predicting mortality was acceptable (AUROC 0.69/0.67). In discriminating the composite outcome and unanticipated ICU admission, both NEWS and NEWS 2 were relatively weak (AUROC 0.62/0.62 and AUROC 0.59/0.60 respectively); for IHCA the performance was poor. There were no differences between NEWS and NEWS 2 as to the predictive power. Conclusion The prognostic accuracy of NEWS 2 to predict mortality within 24 h was acceptable. However, the prognostic accuracy of NEWS 2 to predict IHCA was poor. NEWS and NEWS 2 performed similar in predicting the risk of SAEs but their performances were not sufficient for use as a risk stratification tool in patients assessed by a RRT.
Collapse
Affiliation(s)
- Anna Thorén
- Department of Medicine Solna, Centre for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,Department of Clinical Physiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, SE-118 83 Stockholm, Sweden.,Department of Anaesthesia and Intensive Care, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Lund University, SE-221 84 Lund, Sweden.,Department of Anaesthesia and Intensive Care, Kristianstad Hospital, SE-291 89 Kristianstad, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Johan Engdahl
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Centre for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,Department of Emergency Medicine, Karolinska University Hospital, SE- 171 64 Stockholm, Sweden
| |
Collapse
|