Abstract
Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization.
Highlights
By applying Receiving operating curve (ROC) curve analysis, we found that a National Early Warning Score (NEWS) value higher than 2 predicted hospitalization with an accuracy of 67.5 (62.0; 72.9%) ± 0.03% (p < 0.0001)
By applying ROC curve analysis, we found that a NEWS value higher than 2 predicted hospitalization with an accuracy of 67.5 (62.0; 72.9%) ± 0.03% (p < 0.0001) and a specificity and sensitivity of 63% and 62%, respectively (Figure 6)
As in similar in pre-hospital settings assess thecrew predictive value parameters measurement by observational retrospective studies, we enrolled a significant sample of pre-hospital patients, and we described the prevalence and the distribution of NEWS in a representative population of emergency calls received from our dispatch center [9,10,11,12]
Summary
Identification of clinical deterioration has proven to improve outcomes in the treatment of acute illnesses [1]. Several Early Warning Scores (EWS) have been carried out in different in-hospital settings, each one based on the concept of the track and trigger system (TTS), an approach built on the detection of abnormalities in the main vital signs in order to predict the occurrence of acute adverse events [3]. The EWS is included in the aggregate weighted TTS (AWTTS), in which points are allocated in a weighted manner according to the derangement of variables in the patients’ vital signs from a considered normal range. The sum of the allocated points is known as the Early Warning
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