Abstract
Objective To assess the performance of NEWS for emergency elderly patients with different diseases in China.MethodsA prospective cohort study was carried out by recruiting elderly patients with different diseases from nine hospitals across China.Data of elderly patients admitted between 1 st October, 2013 and 31 May, 2014 were collected and the patients were assessed onsite by using NEWS.The in-hospital death was the ultimate observation.The patients with in-hospital death were compared to those alive with regard to their initial physiological parameters by using Mann-Whitney U test, and Chi-square analysis was applied to Yates' continuity correction.The data were used to create receiver operator characteristic curve (ROC) so that the effectiveness of the scores in determining outcome could be assessed.The different areas under the curve (AUROC) were compared according to the method of Hanley and McNeil.Patients were categorized into different groups according to their primary diseases.Each group's ROC curves were created to assess the effectiveness of the scores among different diseases in determining outcome.Calibration was assessed by using the Hosmer-Lemeshow (H-L) test.P ＜ 0.05 was considered significant.Results Data from 1 528 elderly patients were collected.The AUROC (95％ CI) for the NEWS ability to predict in-hospital death were 0.834 (0.778-0.890).For patients with respiratory, and gastrointestinal diseases, NEWS had good discrimination, as the AUROCs (95％ CI) for NEWS ability to predict mortality were 0.885 (0.816-0.954), and 0.858 (0.737-0.979), respectively.While for patients with cardiovascular diseases, the discrimination of NEWS was not so good, as the AUROCs (95％ CI) for NEWS ability to predict mortality was 0.798 (0.503-1.000).Conclusions The performance of NEWS for emergency elderly patients is valid and reliable.For patients with respiratory, gastrointestinal diseases, NEWS had good performance of discrimination to predict mortality.However, for patients with cardiovascular diseases, the discrimination of NEWS was not so good.Therefore, some corresponding parameters should be added to NEWS to improve its effectiveness of predicting mortality.
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