Alam N, Vegting I L, Houben E, van Berkel B, Vaughan L, Kramer M H H, Nanayakkara P W B
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Section Acute Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
Departments of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
Resuscitation. 2015 May;90:111-5. doi: 10.1016/j.resuscitation.2015.02.011. Epub 2015 Mar 6.
Several triage systems have been developed for use in the emergency department (ED), however they are not designed to detect deterioration in patients. Deteriorating patients may be at risk of going undetected during their ED stay and are therefore vulnerable to develop serious adverse events (SAEs). The national early warning score (NEWS) has a good ability to discriminate ward patients at risk of SAEs. The utility of NEWS had not yet been studied in an ED.
To explore the performance of the NEWS in an ED with regard to predicting adverse outcomes.
A prospective observational study. Patients Eligible patients were those presenting to the ED during the 6 week study period with an Emergency Severity Index (ESI) of 2 and 3 not triaged to the resuscitation room.
NEWS was documented at three time points: on arrival (T0), hour after arrival (T1) and at transfer to the general ward/ICU (T2). The outcomes of interest were: hospital admission, ICU admission, length of stay and 30 day mortality.
A total of 300 patients were assessed for eligibility. Complete data was able to be collected for 274 patients on arrival at the ED. NEWS was significantly correlated with patient outcomes, including 30 day mortality, hospital admission, and length of stay at all-time points.
The NEWS measured at different time points was a good predictor of patient outcomes and can be of additional value in the ED to longitudinally monitor patients throughout their stay in the ED and in the hospital.
已经开发了几种分诊系统用于急诊科（ED），然而它们并非设计用于检测患者病情恶化。病情恶化的患者在急诊科就诊期间可能有未被发现的风险，因此容易发生严重不良事件（SAEs）。国家早期预警评分（NEWS）在区分有SAEs风险的病房患者方面具有良好能力。尚未在急诊科研究NEWS的效用。
探讨NEWS在急诊科预测不良结局方面的表现。
一项前瞻性观察性研究。患者符合条件的患者是在为期6周的研究期间到急诊科就诊、急诊严重程度指数（ESI）为2级和3级且未分诊至复苏室的患者。
在三个时间点记录NEWS：到达时（T0）、到达后1小时（T1）以及转至普通病房/重症监护病房时（T2）。感兴趣的结局包括：住院、入住重症监护病房、住院时间和30天死亡率。
共评估了300例患者的 eligibility。274例患者在到达急诊科时能够收集到完整数据。NEWS与患者结局显著相关，包括所有时间点的30天死亡率、住院和住院时间。
在不同时间点测量的NEWS是患者结局的良好预测指标，在急诊科对患者在整个急诊科及住院期间进行纵向监测时可能具有额外价值。
