• Am J Emerg Med · Jan 2025

    National early warning score 2 plus non-invasive capnography and perfusion index to estimate poor outcomes in emergency departments.

    • Raúl López-Izquierdo, Francisco Martín-Rodríguez, Rut Anel Cuadrillero, Caterina López Villar, Nieves Sobradillo Castrodeza, Isabel Villahoz Cancho, Pedro Á Santos Castro, Elisa A Ingelmo Astorga, Ancor Sanz-García, and Carlos Del Pozo Vegas.
    • Emergency Department, Hospital Universitario Rio Hortega, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
    • Am J Emerg Med. 2025 Jan 6; 90: 162216-22.

    BackgroundThe study of the inclusion of new variables in already existing early warning scores is a growing field. The aim of this work was to determine how capnometry measurements, in the form of end-tidal CO2 (ETCO2) and the perfusion index (PI), could improve the National Early Warning Score (NEWS2).MethodsA secondary, prospective, multicenter, cohort study was undertaken in adult patients with unselected acute diseases who needed continuous monitoring in the emergency department (ED), involving two tertiary hospitals in Spain from October 1, 2022, to June 30, 2023. The primary outcome was 30-day all-cause in-hospital mortality. Demographics and vital signs necessary for NEWS2, ETCO2 and PI were collected.ResultsA total of 687 patients were included in the study. The median age was 79 years (IQR: 69-86), and 36.7 % were females, with an in-hospital mortality rate of 6.7 %. The NEWS2 score was 7 points for nonsurvivors and 4 points for survivors (p < 0.001). The EtCO2 levels were 30 mmHg (26-35) and 23  mmHg (16-30), and the PI levels were 4.7% (2.2-8.1) and 2.5 % (0.98-4.4) for survivors and nonsurvivors, respectively (both p < 0.001). The discrimination capacity of NEWS2 was AUC = 0.769 (95 % CI: 0.707-0.831), that of EtCO2 + PI was AUC = 0.737 (95 % CI: 0.66-0.814), and that of NEWS2 + ETCO2 + PI was AUC = 0.804 (95 % CI: 0.745-0.863).ConclusionsThe present study findings indicate that the PI and ETCO2 improved the ability of the NEWS2 to predict 30-day in-hospital mortality. The novel association of the NEWS2 with the PI and ETCO2 should be considered since it could improve the identification of patients at risk of clinical worsening.Copyright © 2025 Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…