Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
J Emerg Med. 2020 Jun;58(6):882-891. doi: 10.1016/j.jemermed.2020.03.032. Epub 2020 May 4.
Decompensation on the medical floor is associated with increased in-hospital mortality.
Our aim was to determine the accuracy of the National Early Warning Score (NEWS) in predicting early, unplanned escalation of care in patients admitted to the hospital from the emergency department (ED) compared to the Shock Index (SI) and the quick Sepsis-Related Organ Failure Assessment (qSOFA) score.
We conducted a retrospective cohort study of patients admitted directly from the ED to monitored or unmonitored beds (November 9, 2015 to April 30, 2018) in 3 hospitals. Interhospital transfers were excluded. Patient data, vital status, and bed assignment were extracted from the electronic medical record. Scores were calculated using the last set of vital signs prior to leaving the ED. Primary endpoint was in-hospital death or placement in an intermediate or intensive care unit within 24 h of admission from the ED. Scores were compared using the area under the receiver operating curve (AUROC).
Of 46,018 ED admissions during the study window, 39,491 (85.8%) had complete data, of which 3.7% underwent escalation in level of care within 24 h of admission. NEWS outperformed (AUROC 0.69; 95% confidence interval [CI] 0.68-0.69) qSOFA (AUROC 0.63; 95% CI 0.62-0.63; p < 0.001) and SI (AUROC 0.60; 95% CI 0.60-0.61; p < 0.001) at predicting unplanned escalations or death at 24 h.
This multicenter study found NEWS was superior to the qSOFA score and SI in predicting early, unplanned escalation of care for ED patients admitted to a general medical-surgical floor.
医疗楼层的失代偿与住院死亡率增加有关。
我们的目的是确定国家早期预警评分（NEWS）在预测从急诊科（ED）入院的患者早期、非计划的护理升级方面的准确性，与休克指数（SI）和快速脓毒症相关器官衰竭评估（qSOFA）评分相比。
我们对 3 家医院从 ED 直接转入监测或非监测床位的患者（2015 年 11 月 9 日至 2018 年 4 月 30 日）进行了回顾性队列研究。排除了医院间转院的患者。从电子病历中提取患者数据、生命状态和床位分配情况。评分是使用离开 ED 前的最后一组生命体征计算得出的。主要终点是 ED 入院后 24 小时内院内死亡或进入中级或重症监护病房。使用接收者操作特征曲线下的面积（AUROC）比较评分。
在研究期间，46018 例 ED 就诊患者中，有 39491 例（85.8%）数据完整，其中 3.7%在入院后 24 小时内护理水平升级。NEWS 的表现优于 qSOFA（AUROC 0.69；95%置信区间 [CI] 0.68-0.69）和 SI（AUROC 0.60；95% CI 0.60-0.61；p<0.001），预测 ED 患者入院后 24 小时内非计划升级或死亡的准确性更高。
这项多中心研究发现，NEWS 在预测 ED 患者转入普通内科-外科楼层时早期、非计划的护理升级方面优于 qSOFA 评分和 SI。
