Torvik Marianne Ask, Nymo Stig Haugset, Nymo Ståle Haugset, Ofstad Eirik Hugaas
Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway.
Division of Medicine, Nordland Hospital Trust, Bodø, Norway.
Scand J Trauma Resusc Emerg Med. 2025 Jun 13;33(1):105. doi: 10.1186/s13049-025-01371-w.
The National Early Warning Score (NEWS) is implemented internationally for in-hospital monitoring. It has been superior to other predictive scores, but its preventive abilities are still unclear. Additionally, data on patients who experience critical events but are not identified by NEWS as being at risk are scarce. We aimed to explore the National Early Warning Score (NEWS) as an actionable trigger to flag high-risk patients for unplanned transfers from a ward to an intensive care unit (ICU).
Single-centre, retrospective study with case record reviews of all adult, unplanned ICU admissions from a ward to an ICU (level 2 and/ or level 3 ICU) for one year in a Norwegian, 200-bed, urban hospital. We examined the portion of patients flagged by a NEWS of five or seven within 24 h of an ICU transfer, if there was a change in NEWS from the previous 48 h, and how NEWS findings in this patient population differed from a general ward population.
Among 264 unplanned transfers from a ward to an ICU, 164 (62%) and 121 (46%) were flagged by a NEWS of five or seven, respectively. Up to 31% had a change in their NEWS, crossing the five-threshold from the previous 48 h. In contrast, nearly one in five (2077 of 11,310) of all adult admissions to the wards had at least one NEWS of five or higher, though with large variations between departments.
NEWS did not predictably identify patients who were urgently transferred to an ICU from a ward. Less than one-third could have been identified by a recent change in their NEWS, and more than one-third did not meet the criteria of a moderately high NEWS (of five). In addition, a large portion of the ward population have NEWS of five or higher during their hospital stay. Our study emphasizes the vital role of clinical judgment in interaction with early warning scores.
国家早期预警评分（NEWS）在国际上用于医院内监测。它已优于其他预测评分，但其预防能力仍不明确。此外，关于经历危急事件但未被NEWS识别为有风险的患者的数据很少。我们旨在探讨国家早期预警评分（NEWS）作为一个可操作的触发因素，以标记高风险患者进行从病房到重症监护病房（ICU）的非计划转运。
在挪威一家拥有200张床位的城市医院进行单中心回顾性研究，对所有成年患者从病房到ICU（2级和/或3级ICU）的非计划ICU入院病例记录进行审查，为期一年。我们检查了在ICU转运前24小时内NEWS评分为5或7的患者比例、与前48小时相比NEWS是否有变化，以及该患者群体的NEWS结果与普通病房人群有何不同。
在264例从病房到ICU的非计划转运中，分别有164例（62%）和121例（46%）被NEWS评分为5或7标记。高达31%的患者NEWS有变化，较前48小时跨越了5分的阈值。相比之下，所有成年病房入院患者中近五分之一（11310例中的2077例）至少有一次NEWS评分为5或更高，尽管各科室之间差异很大。
NEWS不能可靠地识别从病房紧急转运至ICU的患者。不到三分之一的患者可通过近期NEWS变化被识别，超过三分之一的患者不符合中度高风险NEWS（5分）标准。此外，很大一部分病房患者在住院期间NEWS评分为5或更高。我们的研究强调了临床判断与早期预警评分相互作用中的关键作用。
