Evaluation of the efficacy of the National Early Warning Score in predicting in-hospital mortality via the risk stratification

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Authors: Young Seok Lee ; Jae Woo Choi ; Yeon Hee Park ; Chaeuk Chung ; Dong Il Park ; Jeong Eun Lee ; Hye Sun Lee ; Jae Young Moon

MeSH: Adult ; Aged ; Critical Care / organization & administration* ; Critical Illness / mortality* ; Female ; Hospital Mortality / trends* ; Humans ; Intensive Care Units / organization & administration* ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment

Keywords: Hospital mortality ; National Early Warning Score ; Prognosis ; Rapid response system ; Screening

Abstract: Purpose: To investigate the efficacy of the National Early Warning Score (NEWS) in predicting in-hospital mortality.

Materials and methods: This was a retrospective observational study and the electronic medical records of the patients were reviewed based on NEWS at the time of admission.

Results: The performance of NEWS was effective in predicting hospital mortality (area under the curve: 0.765; 95% confidence interval: 0.659-0.846). Based on the Kaplan Meier survival curves, the survival time of patients who are at high risk according to NEWS was significantly shorter than that of patients who are at low risk (p < 0.001). Results of the multivariate Cox proportional hazards regression analysis showed that the hazard ratios of patients who are at medium and high risk based on NEWS were 2.6 and 4.7, respectively (p < 0.001). In addition, our study showed that the combination model that used other factors, such as age and diagnosis, was more effective than NEWS alone in predicting hospital mortality (NEWS: 0.765; combination model: 0.861; p < 0.005).

Conclusions: NEWS is a simple and useful bedside tool for predicting in-hospital mortality. In addition, the rapid response team must consider other clinical factors as well as screening tools to improve clinical outcomes.