Validating the National Early Warning Score(NEWS) in Emergency Department of a tertiary care hospital in Pakistan.

Abstract

BACKGROUND National Early Warning Score has been studied well in indoor settings of developed countries but hasn’t been tested before in the Emergency Department of developing countries with fewer resources. Our objective was to determine whether the emergency department (ED) NEWS can be associated with Triage, admission, disposition, length of emergency/hospital stay, reappearance and mortality. METHODOLOGY A random sample of 1000 patients’ first encounter in the ED was extracted in the study period (between November 2018 and April 2019). Statistical analysis was done to analyze whether ED NEWS severity category can be associated with Triage, admission, disposition, length of emergency stay, length of hospital stay, reappearance in two weeks and mortality. RESULTS ED NEWS Score is associated with triage as shown by mean 2.68 (SD ± 0.6, p=0.01). Also, a high NEWS score also had impact on admission including 75 (66.4%) patients in severe and 55(74.3%) in moderate NEWS severity category respectively. NEWS score is also associated with Critical care admission and length of Emergency stay likely hood ratio of 26.0(p=0.038). Reappearance in emergency within next two weeks of discharge had no relation to NEWS severity. On the other hand both ED mortality and Hospital mortality were related to High NEWS. It correlates weakly with Length of Stay in emergency or with Length of Stay in Hospital. CONCLUSION NEWS Score can be used in the emergency department to identify and predict adverse outcome of patients presenting to ED. NEWS can be used as a triage tool when deciding whether and where patients should be admitted.