Naito Takaki, Hayashi Kuniyoshi, Hsu Hsiang-Chin, Aoki Kazuhiro, Nagata Kazuma, Arai Masayasu, Nakada Taka-Aki, Suzaki Shinichiro, Hayashi Yoshiro, Fujitani Shigeki
Department of Emergency and Critical Care Medicine St. Marianna University School of Medicine Kanagawa Japan.
Graduate School of Public Health St. Luke's International University Tokyo Japan.
Acute Med Surg. 2021 May 15;8(1):e666. doi: 10.1002/ams2.666. eCollection 2021 Jan-Dec.
Although rapid response systems (RRS) are used to prevent adverse events, Japan reportedly has low activation rates and high mortality rates. The National Early Warning Score (NEWS) could provide a solution, but it has not been validated in Japan. We aimed to validate NEWS for Japanese patients.
This retrospective observational study included data of 2,255 adult patients from 33 facilities registered in the In-Hospital Emergency Registry in Japan between January 2014 and March 2018. The primary evaluated outcome was mortality rate 30 days after RRS activation. Accuracy of NEWS was analyzed with the correlation coefficient and area under the receiver operating characteristic curve. Prediction weights of NEWS parameters were then analyzed using multiple logistic regression and a machine learning method, classification and regression trees.
The correlation coefficient of NEWS for 30-day mortality rate was 0.95 (95% confidence interval [CI], 0.88-0.98) and the area under the receiver operating characteristic curve was 0.668 (95% CI, 0.642-0.693). Sensitivity and specificity values with a cut-off score of 7 were 89.8% and 45.1%, respectively. Regarding prediction values of each parameter, oxygen saturation showed the highest odds ratio of 1.36 (95% CI, 1.25-1.48), followed by altered mental status 1.23 (95% CI, 1.14-1.32), heart rate 1.21 (95% CI, 1.09-1.34), systolic blood pressure 1.12 (95% CI, 1.04-1.22), and respiratory rate 1.03 (95% CI, 1.05-1.26). Body temperature and oxygen supplementation were not significantly associated. Classification and regression trees showed oxygen saturation as the most heavily weighted parameter, followed by altered mental status and respiratory rate.
National Early Warning Score could stratify 30-day mortality risk following RRS activation in Japanese patients.
尽管快速反应系统（RRS）用于预防不良事件，但据报道日本的激活率较低且死亡率较高。国家早期预警评分（NEWS）可能提供一种解决方案，但尚未在日本得到验证。我们旨在验证针对日本患者的NEWS。
这项回顾性观察性研究纳入了2014年1月至2018年3月期间在日本住院急诊登记处登记的33家机构的2255例成年患者的数据。主要评估结局是RRS激活后30天的死亡率。通过相关系数和受试者工作特征曲线下面积分析NEWS的准确性。然后使用多元逻辑回归和机器学习方法（分类与回归树）分析NEWS参数的预测权重。
NEWS与30天死亡率的相关系数为0.95（95%置信区间[CI]，0.88 - 0.98），受试者工作特征曲线下面积为0.668（95%CI，0.642 - 0.693）。截断分数为7时的敏感性和特异性值分别为89.8%和45.1%。关于每个参数的预测值，氧饱和度的优势比最高，为1.36（95%CI，1.25 - 1.48），其次是精神状态改变1.23（95%CI，1.14 - 1.32）、心率1.21（95%CI，1.09 - 1.34）、收缩压1.12（95%CI，1.04 - 1.22）和呼吸频率1.03（95%CI，1.05 - 1.26）。体温与氧疗无显著相关性。分类与回归树显示氧饱和度是权重最大的参数，其次是精神状态改变和呼吸频率。
国家早期预警评分可以对日本患者RRS激活后的30天死亡风险进行分层。
