• R Lobo, K Lynch, and L F Casserly.
• Department of Medicine, St. John's Hospital, St. John's Square, Limerick City, Limerick, Ireland. DoctorRLobo@gmail.com.
• Ir J Med Sci. 2015 Dec 1; 184 (4): 893-8.

ObjectiveThe national early warning score (NEWS) was developed to detect the early signs of patient deterioration with a view to instituting higher levels of care. There is a concern about the sensitivity of the NEWS score in patients with chronic hypoxaemic conditions.MethodsThis cross-sectional audit sought to determine the clinical relevance of a NEWS score of 7 or higher in medical patients by determining whether there was any change in clinical management. Patients with chronic hypoxaemic conditions had a modified early warning score applied retrospectively, the chronic respiratory early warning score (CREWS) to determine if it made a difference to the trigger threshold. The study also aimed to determine the discharge outcome of such patients.ResultsA NEWS score ≥7 did not result in a change in clinical management in 64.6% of cases; 94.1% of patients with no change in clinical management were subsequently discharged home. Oxygen supplementation and oxygen saturation were the primary determinants of elevated NEWS scores with 89.9 and 31.6% of cases having high scores, respectively; 19.7% of patients were receiving home oxygen therapy. Retrospective application of the CREWS scoring system in these patients would have reduced the number of reviews by 70.3%.ConclusionsIn medical patients admitted to a Model 2 hospital with chronic respiratory illness, the 'respiratory variables' of the NEWS score are poor discriminators of patients who are clinically deteriorating. Better tools (such as the CREWS score) are required to distinguish acutely ill from chronically ill patients with respiratory disease in Model 2 hospitals.

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