Nissen Søren K, Candel Bart G J, Nickel Christian H, de Jonge Evert, Ryg Jesper, Bogh Søren B, de Groot Bas, Brabrand Mikkel
Institute of Regional Health Research, Center South-West Jutland, University of Southern Denmark, Esbjerg, Denmark; Department of Emergency Medicine, Hospital of South-West Jutland, Esbjerg, Denmark.
Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Emergency Medicine, Máxima Medical Center, Veldhoven, the Netherlands.
Ann Emerg Med. 2022 Apr;79(4):354-363. doi: 10.1016/j.annemergmed.2021.09.434. Epub 2021 Nov 4.
To investigate how age affects the predictive performance of the National Early Warning Score (NEWS) at arrival to the emergency department (ED) regarding inhospital mortality and intensive care admission.
International multicenter retrospective cohorts from 2 Danish and 3 Dutch ED. Development cohort: 14,809 Danish patients aged ≥18 years with at least systolic blood pressure or pulse measured from the Danish Multicenter Cohort. External validation cohort: 50,448 Dutch patients aged ≥18 years with all vital signs measured from the Netherlands Emergency Department Evaluation Database (NEED). Multivariable logistic regression was used for model building. Performance was evaluated overall and within age categories: 18 to 64 years, 65 to 80 years, and more than 80 years.
In the Danish Multicenter Cohort, a total of 2.5% died inhospital, and 2.8% were admitted to the ICU, compared with 2.8% and 1.6%, respectively, in the NEED. Age did not add information for the prediction of intensive care admission but was the strongest predictor for inhospital mortality. For NEWS alone, severe underestimation of risk was observed for persons above 80 while overall Area Under Receiver Operating Characteristic (AUROC) was 0.82 (confidence interval [CI] 0.80 to 0.84) in the Danish Multicenter Cohort versus 0.75 (CI 0.75 to 0.77) in the NEED. When combining NEWS with age, underestimation of risks was eliminated for persons above 80, and overall AUROC increased significantly to 0.86 (CI 0.85 to 0.88) in the Danish Multicenter Cohort versus 0.82 (CI 0.81 to 0.83) in the NEED.
Combining NEWS with age improved the prediction performance regarding inhospital mortality, mostly for persons aged above 80, and can potentially improve decision policies at arrival to EDs.
探讨年龄如何影响国家早期预警评分（NEWS）在急诊入院时对院内死亡率和重症监护病房收治情况的预测性能。
来自2家丹麦和3家荷兰急诊科的国际多中心回顾性队列研究。开发队列：14809名年龄≥18岁的丹麦患者，其收缩压或脉搏至少有一项是从丹麦多中心队列中测量得到的。外部验证队列：50448名年龄≥18岁的荷兰患者，其所有生命体征均来自荷兰急诊科评估数据库（NEED）。采用多变量逻辑回归进行模型构建。在总体以及年龄组（18至64岁、65至80岁和80岁以上）内对性能进行评估。
在丹麦多中心队列中，2.5%的患者在院内死亡，2.8%的患者被收治入重症监护病房，而在NEED中这两个比例分别为2.8%和1.6%。年龄对于预测重症监护病房收治情况并无额外信息贡献，但却是院内死亡率最强的预测因素。仅就NEWS而言，80岁以上人群的风险被严重低估，丹麦多中心队列的总体受试者操作特征曲线下面积（AUROC）为0.82（置信区间[CI] 0.80至0.84），而在NEED中为0.75（CI 0.75至0.77）。当将NEWS与年龄相结合时，80岁以上人群的风险低估情况得以消除，丹麦多中心队列的总体AUROC显著提高至0.86（CI 0.85至0.88），而在NEED中为0.82（CI 0.81至0.83）。
将NEWS与年龄相结合可提高院内死亡率的预测性能，主要针对80岁以上人群，并且可能改善急诊入院时的决策策略。
