• Am J Emerg Med · Feb 2020

    Observational Study

    Triage in Emergency Department Early Warning Score (TREWS) is predicting in-hospital mortality in the emergency department.

    • Sang Bong Lee, Dong Hoon Kim, Taeyun Kim, Changwoo Kang, Soo Hoon Lee, Jin Hee Jeong, Seong Chun Kim, Yong Joo Park, and Daesung Lim.
    • Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816beon-gil, Jinju-si, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea.
    • Am J Emerg Med. 2020 Feb 1; 38 (2): 203-210.

    AimThe purpose is to assess the adequacy of the National Early Warning Score (NEWS) in the emergency department (ED) and the usefulness of the Triage in Emergency Department Early Warning Score (TREWS) that has been developed using the NEWS in the ED.MethodsIn this retrospective observational cohort study, we performed univariable and multivariable regression analyses with 81,520 consecutive ED patients to develop a new scoring system, the TREWS. The primary outcome was in-hospital mortality within 24 h, and secondary outcomes were in-hospital mortality within 48 h, 7 days, and 30 days. The prognostic properties of the TREWS were compared with those of the NEWS, Modified Early Warning Score (MEWS), and Rapid Emergency Medicine Score (REMS) using the area under the receiver operating characteristic curve (AUC) technique.ResultsThe AUC of the TREWS for in-hospital mortality within 24 h was 0.906 (95% CI, 0.903-0.908), those of the NEWS, MEWS, and REMS were 0.878 (95% CI, 0.875-0.881), 0.857 (95% CI, 0.854-0.860), and 0.834 (95% CI, 0.831-0.837), respectively. Differences in the AUC between the TREWS and NEWS, the TREWS and MEWS, and the TREWS and REMS were 0.028 (95% CI, 0.022-0.033; p < .001), 0.049 (95% CI, 0.041-0.057; p < .001), and 0.072 (95% CI, 0.063-0.080; p < .001), respectively. The TREWS showed significantly superior performance in predicting secondary outcomes.ConclusionThe TREWS predicts in-hospital mortality within 24 h, 48 h, 7 days, and 30 days better than the NEWS, MEWS, and REMS for patients arriving at the ED.Copyright © 2019 Elsevier Inc. All rights reserved.

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