Spagnolli Walter, Rigoni Marta, Torri Emanuele, Cozzio Susanna, Vettorato Elisa, Nollo Giandomenico
Azienda Provinciale per i Sevizi Sanitari, Ospedale Sanata Chiara U.O. Medicina Interna, Trento, Italy.
Healthcare Research and Innovation Program, Fondazione Bruno Kessler, Trento, Italy.
Int J Clin Pract. 2017 Mar;71(3-4). doi: 10.1111/ijcp.12934. Epub 2017 Mar 9.
We aimed to assess the performance of the National Early Warning Score (NEWS) as tool for patient risk stratification at admission in an acute Internal Medicine ward and to ensure patient placement in ward areas with the required and most appropriate intensity of care. As secondary objective, we considered NEWS performance in two subgroups of patients: sudden cardiac events (acute coronary syndromes and arrhythmic events), and chronic respiratory insufficiency.
We conducted a perspective cohort single centre study on 2,677 unselected patients consecutively admitted from July 2013 to March 2015 in the Internal Medicine ward of the hospital of Trento, Italy. The NEWS was mandatory collected on ward admission. We defined three risk categories for clinical deterioration: low score (NEWS 0-4), medium score (NEWS 5-6), and high score (NEWS≥7). Following adverse outcomes were considered: total and early (<72 hours) in-hospital mortality, urgent transfers to a higher intensity of care. A logistic regression model quantified the association between outcomes and NEWS.
For patients with NEWS >4 vs patients with NEWS <4, the risk of early death increased from 12 to 36 times, total mortality from 3.5 to 9, and urgent transfers from 3.5 to 7. In patients with sudden cardiac events, lower scores were significantly associated with higher risk of transfer to a higher intensity of care. In patients affected by chronic hypoxaemia, adverse outcomes occurred less in medium and high score categories of NEWS.
National Early Warning Score assessed on ward admission may enable risk stratification of clinical deterioration and can be a good predictor of in-hospital serious adverse outcomes, although sudden cardiac events and chronic hypoxaemia could constitute some limits.
我们旨在评估国家早期预警评分（NEWS）作为急性内科病房入院时患者风险分层工具的性能，并确保患者安置在具有所需且最合适护理强度的病房区域。作为次要目标，我们考虑了NEWS在两个患者亚组中的性能：心脏突发事件（急性冠状动脉综合征和心律失常事件）以及慢性呼吸功能不全。
我们对2013年7月至2015年3月期间连续入住意大利特伦托医院内科病房的2677例未经选择的患者进行了一项前瞻性队列单中心研究。NEWS在病房入院时必须收集。我们定义了临床恶化的三个风险类别：低分（NEWS 0 - 4）、中分（NEWS 5 - 6）和高分（NEWS≥7）。考虑了以下不良结局：住院总死亡率和早期（<72小时）住院死亡率、紧急转至更高护理强度。逻辑回归模型量化了结局与NEWS之间的关联。
与NEWS<4的患者相比，NEWS>4的患者早期死亡风险从12倍增加到36倍，总死亡率从3.5%增加到9%，紧急转院率从3.5%增加到7%。在心脏突发事件患者中，较低评分与转至更高护理强度的风险显著相关。在慢性低氧血症患者中，NEWS的中分和高分类别中不良结局发生较少。
入院时评估的国家早期预警评分可能有助于临床恶化的风险分层，并且可以成为住院严重不良结局的良好预测指标，尽管心脏突发事件和慢性低氧血症可能构成一些限制。
