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Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Published online by Cambridge University Press:  25 October 2019

Francisco Martín-Rodríguez Open the ORCID record for Francisco Martín-Rodríguez [Opens in a new window] ,
Raúl López-Izquierdo ,
Carlos del Pozo Vegas ,
Juan F. Delgado Benito ,
Virginia Carbajosa Rodríguez ,
María N. Diego Rasilla ,
José Luis Martín Conty ,
Agustín Mayo Iscar ,
Santiago Otero de la Torre  and
Violante Méndez Martín
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Francisco Martín-Rodríguez
Affiliation:
Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain Advanced Medical Life Support, Gerencia de Emergencias Sanitarias de Castilla y León, Spain
Raúl López-Izquierdo*
Affiliation:
Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
Carlos del Pozo Vegas
Affiliation:
Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
Juan F. Delgado Benito
Affiliation:
Advanced Medical Life Support, Gerencia de Emergencias Sanitarias de Castilla y León, Spain
Virginia Carbajosa Rodríguez
Affiliation:
Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
María N. Diego Rasilla
Affiliation:
Advanced Medical Life Support, Gerencia de Emergencias Sanitarias de Castilla y León, Spain
José Luis Martín Conty
Affiliation:
Faculty of Occupational Therapy, Speech Therapy, and Nursing, Castilla la Mancha University, Talavera de la Reina, Toledo, Spain
Agustín Mayo Iscar
Affiliation:
Department of Statistics and Operative Research & IMUVA, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
Santiago Otero de la Torre
Affiliation:
Advanced Medical Life Support, Gerencia de Emergencias Sanitarias de Castilla y León, Spain
Violante Méndez Martín
Affiliation:
Emergency Department, Complejo Asistencial de Salamanca, Salamanca, Spain
Miguel A. Castro Villamor
Affiliation:
Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
*
Correspondence: Raúl López-Izquierdo, PhD Emergency Department Hospital Universitario Rio Hortega C/ Dulzaina 2. 47012-Valladolid, Spain E-mail: rlopeziz@saludcastillayleon.es
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Abstract

Introduction:

In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.

Hypothesis/Problem:

The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.

Methods:

This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.

Results:

From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).

Conclusion:

Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

Keywords

clinical decision makingearly mortalityearly warning scoremass-casualty incidenttriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 6 , December 2019 , pp. 610 - 618
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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Footnotes

(Note: The first and second authors contributed equally to this manuscript.)

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