• J Emerg Med · Jun 2020

    Multicenter Study

    National Early Warning Score Is Modestly Predictive of Care Escalation after Emergency Department-to-Floor Admission.

    • Mark E Sutherland, Samantha J Yarmis, Daniel L Lemkin, Michael E Winters, and DezmanZachary D WZDWDepartment of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland..
    • Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland.
    • J Emerg Med. 2020 Jun 1; 58 (6): 882-891.

    BackgroundDecompensation on the medical floor is associated with increased in-hospital mortality.ObjectiveOur aim was to determine the accuracy of the National Early Warning Score (NEWS) in predicting early, unplanned escalation of care in patients admitted to the hospital from the emergency department (ED) compared to the Shock Index (SI) and the quick Sepsis-Related Organ Failure Assessment (qSOFA) score.MethodsWe conducted a retrospective cohort study of patients admitted directly from the ED to monitored or unmonitored beds (November 9, 2015 to April 30, 2018) in 3 hospitals. Interhospital transfers were excluded. Patient data, vital status, and bed assignment were extracted from the electronic medical record. Scores were calculated using the last set of vital signs prior to leaving the ED. Primary endpoint was in-hospital death or placement in an intermediate or intensive care unit within 24 h of admission from the ED. Scores were compared using the area under the receiver operating curve (AUROC).ResultsOf 46,018 ED admissions during the study window, 39,491 (85.8%) had complete data, of which 3.7% underwent escalation in level of care within 24 h of admission. NEWS outperformed (AUROC 0.69; 95% confidence interval [CI] 0.68-0.69) qSOFA (AUROC 0.63; 95% CI 0.62-0.63; p < 0.001) and SI (AUROC 0.60; 95% CI 0.60-0.61; p < 0.001) at predicting unplanned escalations or death at 24 h.ConclusionsThis multicenter study found NEWS was superior to the qSOFA score and SI in predicting early, unplanned escalation of care for ED patients admitted to a general medical-surgical floor.Copyright © 2020 Elsevier Inc. All rights reserved.

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