Comparison of the National Early Warning Score in non-elective medical and surgical patients

Caroline Mary Segrave Kovacs; Stuart William Jarvis; David Prytherch; Paul Meredith; Paul E. Schmidt; James Stewart Briggs; Gary Smith

doi:10.1002/bjs.10267

Comparison of the National Early Warning Score in non-elective medical and surgical patients

Caroline Mary Segrave Kovacs, Stuart William Jarvis, David Prytherch, Paul Meredith, Paul E. Schmidt, James Stewart Briggs, Gary Smith

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Abstract

Background - The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties; and to compare the performance of NEWS in admissions to medical and surgical specialties.

Methods - Hospital-wide data over 31 months, from adult inpatients who stayed at least one night or died on the day of admission, were analysed. The data were categorized as elective or non-elective surgical or medical admissions. The ability of NEWS to discriminate the outcomes above in these different groups was assessed using the area under the receiver operating characteristic curve (AUROC).

Results - There were too few outcomes to permit meaningful comparison of elective admissions so the analysis was constrained to comparison of non-elective admissions. NEWS performed equally well, or better, for surgical as for medical patients. For death within 24 h the AUROC for surgical admissions was 0.914 (95 per cent c.i. 0.907 to 0.922), compared with 0.902 (0.898 to 0.905) for medical admissions. For the combined outcome of any of death, cardiac arrest or unanticipated ICU admission, the AUROC was 0.874 (0.868 to 0.880) for surgical admissions and 0.874 (0.871 to 0.877) for medical admissions.

Conclusion - NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients.

Original language	English
Pages (from-to)	1385–1393
Journal	British Journal of Surgery
Volume	103
Issue number	10
Early online date	3 Aug 2016
DOIs	https://doi.org/10.1002/bjs.10267
Publication status	Published - Sept 2016

Keywords

health informatics
clinical outcome modelling
surgery
National Early Warning Score

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10.1002/bjs.10267

Is the UK National Early Warning Score suitable for use in surgical patients 20160425
This is the peer reviewed version of the following article: Kovacs, C., Jarvis, S. W., Prytherch, D. R., Meredith, P., Schmidt, P. E., Briggs, J. S. and Smith, G. B. (2016), Comparison of the National Early Warning Score in non-elective medical and surgical patients. Br J Surg, 103: 1385–1393, which has been published in final form at 10.1002_bjs.10267. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Accepted author manuscript (Post-print), 180 KBLicence: Unspecified

Cite this

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title = "Comparison of the National Early Warning Score in non-elective medical and surgical patients",

abstract = "Background - The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties; and to compare the performance of NEWS in admissions to medical and surgical specialties.Methods - Hospital-wide data over 31 months, from adult inpatients who stayed at least one night or died on the day of admission, were analysed. The data were categorized as elective or non-elective surgical or medical admissions. The ability of NEWS to discriminate the outcomes above in these different groups was assessed using the area under the receiver operating characteristic curve (AUROC).Results - There were too few outcomes to permit meaningful comparison of elective admissions so the analysis was constrained to comparison of non-elective admissions. NEWS performed equally well, or better, for surgical as for medical patients. For death within 24 h the AUROC for surgical admissions was 0.914 (95 per cent c.i. 0.907 to 0.922), compared with 0.902 (0.898 to 0.905) for medical admissions. For the combined outcome of any of death, cardiac arrest or unanticipated ICU admission, the AUROC was 0.874 (0.868 to 0.880) for surgical admissions and 0.874 (0.871 to 0.877) for medical admissions.Conclusion - NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients.",

keywords = "health informatics, clinical outcome modelling, surgery, National Early Warning Score",

author = "Kovacs, {Caroline Mary Segrave} and Jarvis, {Stuart William} and David Prytherch and Paul Meredith and Schmidt, {Paul E.} and Briggs, {James Stewart} and Gary Smith",

note = "12 months embargo. The title of the paper was changed between submission and publication. 26/8/2016: post-publication we have now agreed a small amendment to the title with the publisher.",

year = "2016",

month = sep,

doi = "10.1002/bjs.10267",

language = "English",

volume = "103",

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T1 - Comparison of the National Early Warning Score in non-elective medical and surgical patients

AU - Kovacs, Caroline Mary Segrave

AU - Jarvis, Stuart William

AU - Prytherch, David

AU - Meredith, Paul

AU - Schmidt, Paul E.

AU - Briggs, James Stewart

AU - Smith, Gary

N1 - 12 months embargo. The title of the paper was changed between submission and publication. 26/8/2016: post-publication we have now agreed a small amendment to the title with the publisher.

PY - 2016/9

Y1 - 2016/9

N2 - Background - The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties; and to compare the performance of NEWS in admissions to medical and surgical specialties.Methods - Hospital-wide data over 31 months, from adult inpatients who stayed at least one night or died on the day of admission, were analysed. The data were categorized as elective or non-elective surgical or medical admissions. The ability of NEWS to discriminate the outcomes above in these different groups was assessed using the area under the receiver operating characteristic curve (AUROC).Results - There were too few outcomes to permit meaningful comparison of elective admissions so the analysis was constrained to comparison of non-elective admissions. NEWS performed equally well, or better, for surgical as for medical patients. For death within 24 h the AUROC for surgical admissions was 0.914 (95 per cent c.i. 0.907 to 0.922), compared with 0.902 (0.898 to 0.905) for medical admissions. For the combined outcome of any of death, cardiac arrest or unanticipated ICU admission, the AUROC was 0.874 (0.868 to 0.880) for surgical admissions and 0.874 (0.871 to 0.877) for medical admissions.Conclusion - NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients.

AB - Background - The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties; and to compare the performance of NEWS in admissions to medical and surgical specialties.Methods - Hospital-wide data over 31 months, from adult inpatients who stayed at least one night or died on the day of admission, were analysed. The data were categorized as elective or non-elective surgical or medical admissions. The ability of NEWS to discriminate the outcomes above in these different groups was assessed using the area under the receiver operating characteristic curve (AUROC).Results - There were too few outcomes to permit meaningful comparison of elective admissions so the analysis was constrained to comparison of non-elective admissions. NEWS performed equally well, or better, for surgical as for medical patients. For death within 24 h the AUROC for surgical admissions was 0.914 (95 per cent c.i. 0.907 to 0.922), compared with 0.902 (0.898 to 0.905) for medical admissions. For the combined outcome of any of death, cardiac arrest or unanticipated ICU admission, the AUROC was 0.874 (0.868 to 0.880) for surgical admissions and 0.874 (0.871 to 0.877) for medical admissions.Conclusion - NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients.

KW - health informatics

KW - clinical outcome modelling

KW - surgery

KW - National Early Warning Score

U2 - 10.1002/bjs.10267

DO - 10.1002/bjs.10267

M3 - Article

SN - 0007-1323

VL - 103

SP - 1385

EP - 1393

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 10

ER -

Comparison of the National Early Warning Score in non-elective medical and surgical patients

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Keywords

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