Hu Wei, Shang Ke, Chen Liqin, Wang Xin, Li Xia
School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China.
People's Hospital of Shangrao, Shangrao, China.
Front Neurol. 2024 Aug 6;15:1435809. doi: 10.3389/fneur.2024.1435809. eCollection 2024.
This study aims to assess the effectiveness of the National Early Warning Score 2 (NEWS2) versus Glasgow Coma Scale (GCS) in predicting hospital mortality among patients with stroke and traumatic brain injury (TBI).
This multicenter study was conducted at two anonymized tertiary care hospitals in distinct climatic regions of China, with a combined annual emergency admission exceeding 10,000 patients.
The study included 2,276 adult emergency admissions diagnosed with stroke ( = 1,088) or TBI ( = 1,188) from January 2021 to December 2023, excluding those with chronic pulmonary disease, severe cardiac conditions, or a history of brain surgery.
The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to analyze the predictive accuracy of NEWS2 and GCS for hospital mortality at 24, 48, and 72 h post-admission and at discharge.
Out of 2,276 patients (mean age 61.4, 65.6% male), 1855 survived while 421 succumbed. NEWS2 demonstrated superior predictive accuracy (AUC = 0.962) over GCS (AUC = 0.854) for overall hospital mortality. Specifically, NEWS2 outperformed GCS in predicting mortality at 24 h (0.917 vs. 0.843), 48 h (0.893 vs. 0.803), and 72 h (0.902 vs. 0.763). Notably, despite a higher AUC for NEWS2 at predicting 24-h hospital mortality, the sensitivity and specificity of GCS were considerably lower (12 and 31%, respectively) compared to NEWS2 (sensitivity of 95% and specificity of 81%). Subgroup analysis showed NEWS2 outperforming GCS in predicting in-hospital mortality for TBI and stroke patients. For TBI patients ( = 260), NEWS2 had an AUC of 0.960 (95% CI: 0.948-0.973) vs. GCS's AUC of 0.811 (95% CI: 0.781-0.840). For stroke patients ( = 161), NEWS2 had an AUC of 0.930 (95% CI: 0.908-0.952) vs. GCS's AUC of 0.858 (95% CI, 0.823-0.892). NEWS2 showed greater sensitivity in both groups, highlighting its effectiveness in identifying high-risk neurological patients.
NEWS2 scores are more precise and effective in predicting hospital mortality in stroke and TBI patients compared to GCS scores, although slightly less so within the first 24 h. Combining NEWS2 with GCS and clinical findings within the initial 24 h is recommended for a comprehensive prognosis evaluation.
本研究旨在评估国家早期预警评分2（NEWS2）与格拉斯哥昏迷量表（GCS）在预测中风和创伤性脑损伤（TBI）患者医院死亡率方面的有效性。
本多中心研究在中国不同气候区域的两家匿名三级护理医院进行，两家医院每年急诊入院患者总数超过10000例。
本研究纳入了2021年1月至2023年12月期间2276例诊断为中风（n = 1088）或TBI（n = 1188）的成年急诊患者，排除患有慢性肺病、严重心脏疾病或有脑外科手术史的患者。
采用受试者工作特征（ROC）曲线和曲线下面积（AUC）分析NEWS2和GCS在入院后24、48和72小时以及出院时对医院死亡率的预测准确性。
在2276例患者（平均年龄61.4岁，65.6%为男性）中，1855例存活，421例死亡。在预测总体医院死亡率方面，NEWS2的预测准确性（AUC = 0.962）优于GCS（AUC = 0.854）。具体而言，NEWS2在预测24小时（0.917对0.843）、48小时（0.893对0.803）和72小时（0.902对0.763）死亡率方面优于GCS。值得注意的是，尽管NEWS2在预测24小时医院死亡率时AUC较高，但与NEWS2相比，GCS的敏感性和特异性相当低（分别为12%和31%），而NEWS2的敏感性为95%，特异性为81%。亚组分析显示，在预测TBI和中风患者的院内死亡率方面，NEWS2优于GCS。对于TBI患者（n = 260），NEWS2的AUC为0.960（95%CI：0.948 - 0.973），而GCS的AUC为0.811（95%CI：0.781 - 0.840）。对于中风患者（n = 161），NEWS2的AUC为0.930（95%CI：0.908 - 0.952），而GCS的AUC为0.858（95%CI，0.823 - 0.892）。NEWS2在两组中均显示出更高的敏感性，突出了其在识别高危神经科患者方面的有效性。
与GCS评分相比，NEWS2评分在预测中风和TBI患者的医院死亡率方面更精确有效，尽管在最初24小时内略逊一筹。建议在最初24小时内将NEWS与GCS及临床检查结果相结合，以进行全面预后评估。
