Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Anesthesiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
BMC Emerg Med. 2022 Mar 14;22(1):42. doi: 10.1186/s12873-022-00598-5.
In Iran, the emergency departments (EDs) have largely adopted the emergency severity index (ESI) to prioritize the emergency patients, however emergency medical services (EMS) mainly triage the patients based on the paramedics' gestalt. The National Early Warning Score (NEWS) is a recommended prehospital triage in the UK. We aimed to compare prehospital NEWS and ED ESI for predicting severe outcomes in emergency patients.
An observational study was conducted in a university-affiliated ED between January and April 2021. Adult patients who arrived in the ED by EMS were included. EMS providers calculated the patients' NEWS upon arriving on the scene using an Android NEWS application. In the ED, triage nurses utilized the ESI algorithm to prioritize patients with higher clinical risk. Then, Research nurses recorded patients' 30-day severe outcomes (death or ICU admission). Finally, The prognostic properties of ESI and NEWS were evaluated.
One thousand forty-eight cases were included in the final analysis, of which 29 (2.7%) patients experienced severe outcomes. The difference between the prehospital NEWS and ED ESI in predicting severe outcomes was not statistically significant (AUC = 0.825, 95% CI: 0.74-0.91 and 0.897, 95% CI, 0.83-0.95, for prehospital NEWS and ESI, respectively).
Our findings indicated that prehospital NEWS compares favorably with ED ESI in predicting 30-day severe outcomes in emergency patients.
在伊朗，急诊科（ED）主要采用紧急严重指数（ESI）对急诊患者进行优先分级，但急救医疗服务（EMS）主要根据护理人员的整体评估对患者进行分类。英国推荐使用早期预警评分（NEWS）进行院前分诊。我们旨在比较院前 NEWS 和 ED ESI 对预测急诊患者严重结局的作用。
这是一项在 2021 年 1 月至 4 月期间在一所大学附属医院的 ED 进行的观察性研究。纳入通过 EMS 到达 ED 的成年患者。EMS 提供者使用基于 Android 的 NEWS 应用程序在到达现场时计算患者的 NEWS。在 ED，分诊护士使用 ESI 算法对具有更高临床风险的患者进行优先分类。然后，研究护士记录患者的 30 天严重结局（死亡或 ICU 入院）。最后，评估 ESI 和 NEWS 的预后特性。
最终分析纳入 1048 例患者，其中 29 例（2.7%）患者出现严重结局。院前 NEWS 和 ED ESI 在预测严重结局方面的差异无统计学意义（AUC=0.825，95%CI：0.74-0.91 和 0.897，95%CI：0.83-0.95，分别为院前 NEWS 和 ESI）。
我们的研究结果表明，院前 NEWS 在预测急诊患者 30 天严重结局方面与 ED ESI 相当。
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