Özgür ATMACA, Can TURAN, Pınar GÜVEN, Hüseyin ARIKAN, S. Emel ERYÜKSEL, Sait KARAKURT

Usage of NEWS for prediction of mortality and in-hospital cardiac arrest rates in a Turkish university hospital

Background/aim: Early warning scores (EWS), widely used around the world but not yet in Turkey, are composed of physiological parameters designed to determine potentially worsening patients to perform necessary interventions in time. The aim is to determine the national EWS (NEWS) of the patients to assess the relation between this score and length of hospital stay (LOHS), transfer to the ICU, 24-h and 28-day mortality rates, and the frequency of in-hospital cardiac arrest (IHCA). Materials and methods: NEWS of all the patients in the internal medicine clinics were calculated via a point prevalence study. The LOHS, transfer to the ICU, rates of mortality in the 24-h and 28-day period, IHCA rate, and the period of the stay in the ICU parameters were determined. Results: Out of 104 patients, 84 of them had low scores (<5), while 20 had mid/high scores. In mid/high-score group (score ≥ 5), transfer to the ICU, IHCA rate, and mortality rates within 24 h and 28 days were significantly higher. Conclusion: In this, the first prospective study about EWS in Turkey, 24-h and 28-day mortality rates, transfer to the ICU, and IHCA frequency of the patients with mid/high NEWS were higher. Key words: National early warning score, cardiac arrest, intensive care unit, mortality

Keywords:

National early warning score, cardiac arrest, intensive care unit, mortality,

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Tanrıöver MS. Recognizing the deteriorating patient prior to cardiac arrest: predictive criteria and risk factors. Yoğun Bakim Dergisi 2011; 2: 16-20 (article in Turkish with an abstract in English).
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Brit Med J 2002; 324: 387-390.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179: 283-287.
Goldhill DR, McNarry AF, Hadjianastassiou VG, Tekkis PP. The longer patients are in hospital before Intensive Care admission the higher their mortality. Intensive Care Med 2004; 30: 1908-1913.
Goldhill DR, McNarry AF, Mandersloot G, McGinley A. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia 2005; 60: 547-553.
Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 1998; 26: 1337-1345.
Sax FL, Charlson ME. Medical patients at high risk for catastrophic deterioration. Crit Care Med 1987; 15: 510-515.
Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34: 2463-2478.
Frost SA, Alexandrou E, Bogdanovski T, Salamonson Y, Parr MJ, Hillman KM. Unplanned admission to intensive care after emergency hospitalisation: risk factors and development of a nomogram for individualising risk. Resuscitation 2009; 80: 224-230.
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM- Mon J Assoc Phys 2001; 94: 521-526.
Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, Forni LG. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population- based single-centre study. Br J Anaesth 2007; 98: 769-774.
Groarke JD, Gallagher J, Stack J, Aftab A, Dwyer C, McGovern R, Courtney G. Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Emerg Med J 2008; 25: 803-806.
National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS Report of a working party. London: Royal College of Physicians, 2012.
Roberts D, Djarv T. Preceding national early warnings scores among in-hospital cardiac arrests and their impact on survival. Am J Emerg Med 2017; 35: 1601-1606.
Singer AJ, Ng J, Thode HC Jr, Spiegel R, Weingart S. Quick SOFA scores predict mortality in adult emergency department patients with and without suspected infection. Ann Emerg Med 2017; 69: 475-479.
Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, Edelson DP. Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. Am J Respir Crit Care Med 2017; 195: 906-911.
Bannard-Smith J, Lighthall GK, Subbe CP, Durham L, Welch J, Bellomo R, Jones DA. Clinical outcomes of patients seen by Rapid Response Teams: a template for benchmarking international teams. Resuscitation 2016; 107: 7-12.
Petersen JA, Antonsen K, Rasmussen LS. Frequency of early warning score assessment and clinical deterioration in hospitalized patients: a randomized trial. Resuscitation 2016; 101: 91-96.
Delgado-Hurtado JJ, Berger A, Bansal AB. Emergency department Modified Early Warning Score association with admission, admission disposition, mortality, and length of stay. J Community Hosp Intern Med Perspect 2016; 6: 31456.
Sbiti-Rohr D, Kutz A, Christ-Crain M, Thomann R, Zimmerli W, Hoess C, Henzen C, Mueller B, Schuetz P. The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study. Brit Med J Open 2016; 6.