Early Warning Score Research Articles

Comparison of Early Warning Scores in Determining the Prognosis of COVID-19 Patients.

Tocompare the effectiveness of early warning score systems in predicting 30-day poor outcomes in Coronavirus Disease (COVID-19) patients admitted to the emergency department. Descriptivestudy. Place and and Duration of the Study: Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkiye, from March 2020 to March 2021. The patients who presented to the emergency department, diagnosed with COVID-19 and tested positive for polymerase chain reaction were analysed. The study included the calculation of the rapid emergency medicine score, risk stratification in the emergency department in acutely ill older patients score, 4C mortality score, and modified early warning score for the patients. These scores were then compared in terms of their ability to predict adverse outcomes, defined as intensive care admission and/or mortality. During the study period, 10,281 COVID-19 patients were admitted to the emergency department. Out of them, 1,826 patients were included in the study. There were 159 (8.7%) cases with poor outcomes. The risk stratification in the emergency department in acutely ill older patients Score was the most successful in poor prognosis. Based on the findings of this study, the risk stratification in the emergency department in acutely ill older patients score demonstrated greater efficacy compared to other early warning scores in identifying patients diagnosed with COVID-19 who had an early indication of a poor prognosis. Early warning score, 4C mortality score, REMS, Rise-up score, MEWS, Emergency department, COVID-19.

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood...

Study protocol of a national multicentre prospective evaluation study assessing the validity and impact of the Dutch Paediatric Early Warning Score (PEWS) in the Netherlands

IntroductionEarly recognition of clinical deterioration and timely intervention are important to improve morbidity and mortality in paediatric care. The Paediatric Early Warning Score (PEWS) is a scoring system aiming to...

Identifying high cholesterol in the ambulance setting: a mixed-methods cohort study to tackle health inequality.

Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours. A mixed-methods study between January and December 2022. Patients aged ≥40years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed. Of 203 patients (59% female, mean age 65.7years), 115 (56.7%) had total cholesterol ≥5.1mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n=9; 4.4%), dietary modification (n=7; 3.4%) or no further intervention (n=14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide. Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours.

Utility of emergency department triage tools in predicting the need for intensive respiratory or vasopressor support in adult patients with COVID-19

BackgroundSerum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65 can be used to triage patients in the Emergency Department. They can be used to predict patients with the highest risk of seven-day mortality and need for intensive respiratory or vasopressor support (IRVS). PurposeThe primary purpose was to find the score with the highest AUC in predicting IRVS and mortality at seven days. Additional objective was to find out any independent factors associated with IRVS and mortality. MethodsThe data of adult patients who presented to the Emergency Department (ED) between April 1, 2021 and June 30, 2021 were collected. The WHO score, CRB-65, DS-CRB 65, PMEWS, NEWS2, and qSOFA score were calculated for all patients. Statistical analysis was done and an ROC curve was calculated for all the tools for mortality and need for IRVS at seven days. Findings677 patients presented to the Emergency Department with COVID-19 during the period above. Presence of Diabetes Mellitus (p = 0.001), Hypertension (p = 0.001), and chronic kidney disease(CKD) (p = 0.04) was significantly associated with need for IRVS. Age, duration of symptoms, pulse rate, respiratory rate, room air saturation, mental status at admission, and time to IRVS need were identified as independent predictors of in-hospital mortality. The longer the time to IRVS need from ED arrival, the higher the likelihood of mortality. PMEWS (0.830) had the highest AUC, followed by NEWS2 (0.805). A PMEWS cut-off of 6.5 was 74.2% sensitive and 78.3% specific in predicting the need for IRVS. ROC analysis to predict 7-day mortality showed that PMEWS had an AUC of 0.802 (0.766–0.839). QSOFA performed poorly in predicting IRVS (AUC 0.645) and 7-day mortality (AUC 0.677). ConclusionPMEWS may be used for triaging patients presenting to the Emergency Department with COVID-19 and accurately predicts the need for IRVS and seven day mortality.

Neurological disorders throughout acute SARS-CoV2 infection: A comparative study between vaccinated and non-vaccinated patients

BackgroundThe role of vaccination on Covid-19 severity in neurological patients is still unknown. We aim at describing clinical characteristics and outcomes of breakthrough and unvaccinated Covid-19 patients hospitalized for neurological disorders. MethodsTwo hundred thirty-two Covid-19 patients were admitted to a neuro-Covid Unit form March 1st 2021 to February 28th 2022. Out of the total sample, 74 (32%) were full vaccinated. The prevalence, clinical characteristics, disease severity, expressed by Brescia-COVID Respiratory Severity Scale (BCRSS) and National Early Warning Score 2 (NEWS2), and final outcomes of neurological syndromes were compared between vaccinated and unvaccinated cases.Cox regression analysis was implemented in order to investigate the combined effect of predictors of mortality. ResultsBreakthrough vaccinated cases were older (years 72.4 ± 16.3 vs 67.0 ± 18.9 years, p = 0.029), showed higher pre-admission comorbidity score and Clinical Frailty scale score (4.46 ± 1.6 vs 3.75 ± 2.0, p = 0.008) with no differences in terms of disease progression or mortality rate (16.2% vs 15.2%), compared to full-dose vaccinated patients.Cox-regression analysis showed age and NEWS2 score as the variables with a significant relation to mortality between the two groups, independently from pre-morbid conditions and inflammatory response. ConclusionThis study on breakthrough COVID-19 infection could help identify vulnerable neurological patients with higher risk of poor outcomes.

Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards

ObjectivesThis prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards. Research methodology/designData was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded. SettingThe study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included. Main outcome measuresThe primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes. ResultsIn a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion. ConclusionThe NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety. Implications for clinical practiceThe Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

Comparison of early warning and sepsis scores for mortality prediction in patients with suspected infection admitted to medical intensive care units

Aims: To compare the mortality prediction efficiency of the Modified Early Warning Score (MEWS), Systemic Inflammatory Response Syndrome (SIRS), Sepsis Related Organ Failure Assessment (SOFA), and Quick Sepsis Related Organ Failure Assessment (qSOFA) calculated within 48 hours before ICU admission. Methods: A prospective, noninterventional, observational cohort study enrolled adult patients admitted to medical intensive care units (ICU) with suspected infection in a tertiary care medical center. MEWS SIRS, SOFA, and qSOFA scores were calculated at four different time points: 48, 24, and 8 hours before and at the time of the ICU admission (0. hour). The scores were analyzed for hospital mortality. Results: A total of 120 patients were included. The median age was 68 (IQR 59.8-79) years, and 44.2% of patients were male. Of the study population, 75.8% were admitted to the medical ICU from the emergency department, while the remaining were from the medical wards. Considering the scores observed 48 hours before ICU admission, Odds Ratio (OR) of SIRS≥2 and SOFA≥2 showed a value of 7.6 (95% CI: 1.5-38.0) and 13.2 (95% CI: 2.3-74.3), respectively, while no increase in risk was observed for MEWS and the qSOFA score. Receiver operating characteristic analysis (ROC) performed with the highest scores observed at any time within 48 hours before ICU admission (ICU admission values were omitted) regarding hospital mortality yielded area under the curve (AUC) values (95% CI) of 0.80 (0.72-0.89) for SOFA, 0.66 (0.54-0.76) for MEWS, 0.63 (0.51-0.74) for qSOFA, and 0.61 (0.49-0.73) for SIRS. SOFA had the highest sensitivity of 92.6% (82.7-100.0), whereas qSOFA had the highest specificity of 63.0% (49.1-77.0) for hospital mortality. Conclusion: SOFA score is the most sensitive scoring system to predict hospital mortality in patients admitted to the medical ICU with suspected infection compared to MEWS, SIRS, and qSOFA. Nevertheless, the sepsis and early warning scores should be combined in clinical practice whenever possible.

Clinical performance of the infant nutrition early warning score in routine practice across four international clinical settings in Europe: A study by the ESPGHAN special interest group in clinical malnutrition.

There is a scarcity of nutritional screening tools for use in infants (<1 year). The infant Nutrition Early Warning Score (iNEWS) has been developed to identify infants who need further dietetic review. We introduced the iNEWS into clinical practice and evaluated its performance in Scotland, Belgium, Athens and Bulgaria. Of the 352 infants screened, 72 (20%) were placed in the high iNEWS category, and of these, 70 (97%) were reviewed by a hospital dietitian. iNEWS produced a true positive rate of 80% which increased to 96% after accounting for anticipated misclassified cases due to prematurity. In Belgium, false positive screens had a shorter length of stay (p = 0.014). Otherwise, misclassification was not related to a specific iNEWS component. This study corroborates previous research, underscoring the validity of iNEWS as a dietetic referral tool and demonstrating that it can be integrated into "real-world" clinical practice across international settings with diverse healthcare resources.

The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia.

(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization.

Launch of the Paediatric Early Warning Score must be matched by workforce investment

Launch of the Paediatric Early Warning Score must be matched by workforce investment

National Early Warning Score in Predicting Adverse Outcomes for Patients Admitted to Emergency Department; a Prognostic Accuracy Study.

Overcrowding in emergency departments (ED) is a global concern, emphasizing the need for effective resource allocation. Triage plays a crucial role in prioritizing patients based on medical needs. This study aimed to evaluate the accuracy of National Early Warning Score (NEWS) in predicting the ED patients' outcomes. A cross-sectional study was conducted in two tertiary hospitals in Tehran, Iran, from June to July 2023. Adult patients presenting to ED were included. Data for calculating the NEWs and emergency severity index (ESI), as well as outcomes were recorded by trained nurses, and then the accuracy of each score in predicting the outcomes was evaluated. A total of 2,085 patients were analyzed. The majority were male (57%) with a mean age of 54.4 years. The primary outcome, cardiopulmonary resuscitation (CPR) within 24 hours of admission, occurred in 1.9% of patients, while the need for intensive care unit (ICU) care and/or mechanical ventilation happened in 3.4%, and CPR or need for ICU care and/or mechanical ventilation was observed in 4.3% of studied cases. Each one-point increase in NEWS was associated with a 52% higher likelihood of CPR (95% confidence interval (CI): 1.41 to 1.65, p<0.001). Receiver operating characteristic curve analyses for the NEWS yielded the optimum cut-off value to be 6 for all three outcomes, with an overall area under the curve (AUC) of 0.856 (95% CI: 0.840 to 0.871), 0.834 (95% CI: 0.817 to 0.850), and 0.854 (95% CI: 0.838 to 0.869) for the primary, secondary, and tertiary outcomes, respectively. NEWS ≥ 6 was associated with a higher incidence of adverse outcomes, including ICU admission and need for CPR. The good predictive validity of NEWS highlights its value in identifying patients at higher risk of adverse outcomes.

Real-world implementation of the National Early Warning Score-2 in an acute respiratory unit

IntroductionThe National Early Warning Score-2 (NEWS-2) is used to detect deteriorating patients in hospital settings. We aimed to understand how NEWS-2 functions in the real-life setting of an acute respiratory...

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department.

This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores (EWSs) and three shock indices in early sepsis prediction in the emergency department (ED). We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong. The primary outcome was sepsis (Sepsis-3 definition) within 48 h of ED presentation. Using c-statistics and the DeLong test, we compared 11 EWSs, including the National Early Warning Score 2 (NEWS2), Modified Early Warning Score, and Worthing Physiological Scoring System (WPS), etc., and three shock indices (the shock index [SI], modified shock index [MSI], and diastolic shock index [DSI]), with Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the primary outcome, intensive care unit admission, and mortality at different time points. We analyzed 601 patients, of whom 166 (27.6%) developed sepsis. NEWS2 had the highest point estimate (area under the receiver operating characteristic curve [AUROC] 0.75, 95%CI 0.70-0.79) and was significantly better than SIRS, qSOFA, other EWSs and shock indices, except WPS, at predicting the primary outcome. However, the pooled sensitivity and specificity of NEWS2 ≥ 5 for the prediction of sepsis were 0.45 (95%CI 0.37-0.52) and 0.88 (95%CI 0.85-0.91), respectively. The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point. NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.

Consensus for the Development of a New Early Warning Score for Predicting Patients' Clinical Deterioration in Angola: A Delphi Study.

Background: Nearly 30 years since its inception, the early warning scores (EWSs) remain pivotal, yet variations have emerged for hospital and prehospital use. Aggregated scores, reflecting multiple physiological parameters, outperform single-parameter systems in assessing acute illness severity, though consensus on optimal approaches is lacking. Resource-limited countries, including Angola, lack adapted EWSs, emphasizing the need for cost-effective and adaptable solutions to enhance patient care. Objective: To explore the perspectives of Angolan experts to identify physiological parameters suitable for incorporation into existing EWSs, allowing the development of a new tool adjusted to the healthcare context in Angola. Methods: We conducted a three-round Delphi survey, engaging a national expert panel comprising twenty-five physicians and nurses with expertise in internal medicine, surgery, emergency rooms, intensive care units, and/or teachers at universities or at teaching courses in these fields. Participants were asked to rate items using a five-point Likert scale. Consensus was achieved if the items received a rating ≥ 80% from the panel. Results: Consensus was evident for the inclusion of standard physiological parameters, such as systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, neurological status, and the presence or absence of supplemental oxygen. Furthermore, there was consensus for the consideration of specific items, namely, seizures, jaundice, cyanosis, capillary refill time, and pain-typically not included in the current EWSs. Consensus was reached regarding the exclusion of both oxygen saturation and temperature measurements in healthcare settings where oximeters and thermometers might not be readily available. Conclusion: Angolan experts were able to identify the physiological parameters suitable for incorporation into the basic EWSs. Further study must be conducted to test and validate the impact of the newly suggested vital parameters on the discriminant and predictive capability of a new aggregated model specifically adjusted to the Angolan healthcare setting.

Pulmonary embolism and risk factors of ICU admission: systematic review

To forecast mortality and identify adult patients who required admission to an intensive care unit (ICU), we compared the efficacy of the most widely used early warning scores. The present review assessed the pulmonary embolism and risk factors of ICU admission; systematic review. A search of the literature was conducted in the bibliographic databases PubMed and EMBASE between 2009 and 2022. Each reviewer verified independently that each possibly relevant title and abstract qualified. There were nine studies that were included in the review. National early warning score (NEWS) was the best indicator of ICU admission; however, the modified early warning score (MEWS) performed better in sepsis patients. According to emergency department (ED) Mortality, the NEWS was the most accurate score for predicting mortality in the entire ED population, and the mortality in emergency department sepsis score was the most accurate measure for patients with sepsis. For all endpoints, NEWS and MEWS had good outcomes in the ICU and ED. Numerous investigations should be conducted utilizing various prognostic scores on ED and ICU patients. Anemia in patients with venous thrombosis was associated with a higher risk of ICU admission and mortality.

The development and validation of a novel deep-learning algorithm to predict in-hospital cardiac arrest in ED-ICU (emergency department-based intensive care units): a single center retrospective cohort study

Over recent years, the escalation of patient volumes in emergency departments (ED) worldwide has posed to the delivery of timely critical care. Intensive Care Unit (ICU) services became essential due to increasing acuity in EDs, and previous studies revealed a strong association between prolonged boarding times and unfavorable outcomes. Innovative strategies such as Emergency Department-based Intensive Care Units (ED-ICUs) have been introduced to optimize critical care delivery. Given the higher acuity and mortality rates in ED-ICU patients, the prediction of certain events, such as In-Hospital Cardiac Arrest (IHCA), has become abstruse. Conventional Early Warning Scores (EWSs) were developed to stratify the risk of conventional ICUs, but have never been validated in ED-ICU patients with higher acuity. Moreover, EWSs are predominantly focused on forecasting mortality and lack capability for real-time prediction. Our study aimed to develop and validate a deep-learning-based model to predict IHCA within 24 h in ED-ICU. We included 1975 patients admitted to ED-ICU. The study period was from 01 January 2019 to 31 December 2020. Our model, the Deep-ICU CMS (Central Monitoring System), uses four classic vital signs (blood pressure, heart rate, respiratory rate, and body temperature) as input. The model outperformed conventional EWSs in predicting IHCA and maintained performance even with extended prediction windows; it provided robust prediction within a 24-h window, setting it apart from models with restricted prediction horizons. It achieved notably high sensitivity and specificity, overcoming the alarm fatigue issue that is common in EWSs. This study pioneered IHCA risk stratification in ED-ICU and showcases Deep-ICU CMS as a robust prediction tool that overcomes the limitations of conventional EWSs. Prospective and external validation are now warranted to confirm the impact of Deep-ICU CMS in real-world practice. Given the scarcity of research in ED-ICU, our findings contribute valuable insights to optimizing critical care delivery.

Comparison of Pneumonia-specific Scores, Sepsis Score and Generic Score in Predicting the Severity of Community-acquired Pneumonia: A Cross-sectional Study

Introduction: Pneumonia is defined as inflammation of the pulmonary parenchyma caused by an infectious agent. Community-acquired Pneumonia (CAP) is a heterogeneous disease with a significant disease burden, morbidity, and mortality. Severe Community-acquired Pneumonia (SCAP) has been proven to be associated with increased Intensive Care Unit (ICU) admission, mechanical ventilation, and mortality. Although several severity assessment tools are available, there is a lack of evidence to support one tool over another in patients with pneumonia. Aim: To compare the ability of pneumonia-specific scores {{Confusion, Urea, Respiratory rate, Blood pressure (CURB)- 65 and Expanded CURB-65)}, Sepsis score {quick Sepsisrelated Organ Failure Assessment (qSOFA)}, and Generic score {National Early Warning Score (NEWS)} in predicting SCAP patients at the time of hospital admission. Materials and Methods: This was a hospital-based crosssectional study conducted in the Department of Pulmonary Medicine, Government Hospital for Chest and Communicable Diseases, Andhra Medical College, Visakhapatnam, India, on 100 patients with clinically and radiologically diagnosed CAP over a period of six months from April 2023 to September 2023 after obtaining Institutional ethics clearance and informed consent. All four severity scores (CURB-65, eCURB-65, qSOFA, NEWS) were documented in each patient at the time of admission. Outcomes such as 30-day mortality and ICU admission were measured. Receiver Operating Characteristic (ROC) curve analysis was performed for mortality prediction and ICU admission for all four scoring systems, and statistical analysis was carried out using Statistical Packages for Social Sciences (SPSS) version 24.0. Results: Out of 100 patients, 62 (62%) were males, and the remaining 38 (38%) were females with a mean age of 56±15 years. The number of patients with co-morbidities was 48 (48%). Regarding addictive habits, smoking and alcohol played a significant role at 38% and 33%, respectively. A 30- day mortality was observed in 18 (18%) patients, and 20 (20%) patients received ICU treatment. The frequency of patients with co-morbidities such as Diabetes Mellitus (DM), Hypertension (HTN), Ischaemic Heart Disease (IHD), and Chronic Obstructive Pulmonary Disease (COPD) was 21%, 33%, 5%, and 3%, respectively. For ICU admission as an outcome measure, the Area Under Receiver Operating Characteristics (AUROC) values were as follows: CURB-65: 0.977 (95% CI: 0.949-1.00, p-value &lt;0.001); Expanded CURB-65: 0.966 (95% CI: 0.931-1.00, p-value &lt;0.001); qSOFA: 0.935 (95% CI: 0.881-0.989, p-value &lt;0.001); NEWS score: 0.967 (95% CI: 0.934-1.00, p-value &lt;0.001). Conclusion: In the present study, all four scoring systems were equally effective in detecting the need for ICU admission and predicting 30-day mortality among CAP patients at the time of admission. However, organ-specific tools (CURB-65 (2-3) moderate) have demonstrated valid and effective means of assessing severity compared to sepsis scores and generic tools.

Development of a Clinical Score for Predicting 28-Day Mortality in Geriatric Sepsis Patients; a Cohort study.

Sepsis is a significant and common cause of death and burden among critically ill patients, which has increasing incidence and mortality in adults over 60 and advanced age. This study aimed to develop an easy-to-use clinical tool for assessing 28-day mortality risk in older sepsis patients upon their initial assessment in the emergency department (ED). A retrospective cohort study was conducted using electronic medical records of older (≥60 years) ED patients with suspected sepsis from August 1, 2018, to December 31, 2018. A new prediction score was formulated based on the logistic coefficients of clinical predictors through multivariable regression analyses. Then, the score's screening performance was evaluated and compared to existing scoring systems; Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National early warning score (NEWS), and The Ramathibodi early warning score (REWS); using receiver operating characteristic curve analysis (AuROC). The study included 599 patients with the mean age of 77.13 (range: 60-101) years (56.43% male) and an overall 28-day mortality rate of 7.01%. The newly developed prediction score had seven independent predictors of 28-day mortality: malignancy, dependent status, heart rate, respiratory rate, oxygen saturation, consciousness, and lactate, which demonstrated excellent discriminative ability (AuROC: 0.87, 95% confidence interval (CI): 0.82 - 0.92), significantly outperforming SIRS (AuROC: 0.62), qSOFA (AuROC: 0.72), NEWS (AuROC: 0.74), and REWS (AuROC: 0.71), all with p-values <0.01. The score allowed risk stratification into low-risk (positive likelihood ratio (LR+): 0.37, 95% CI: 0.24 - 0.58) and high-risk (LR+: 4.14, 95% CI: 3.14 - 5.44) groups with sensitivity of 69.0% and specificity of 83.3% at a cut-off point of 6. The novel prediction score demonstrates a remarkable ability to predict 28-day mortality risk in older sepsis patients during their initial ED assessment, offering potential for improved risk stratification and treatment guidance in older patients.

Long-term brain fog and cognitive impairment in previously hospitalized COVID-19 patients.

Limited research exists on COVID-19 associated brain fog, and on the long-term cognitive and psychiatric sequelae in racially and ethnically diverse patients. We characterize the neuropsychological sequelae of post-acute COVID-19 in a diverse cohort and investigate whether COVID-19 clinical severity remains associated with brain fog and cognitive deficits approximately 2 years post infection. A cross-sectional study of patients with a history of COVID-19 hospitalization (March-September 2020). COVID-19 clinical severity was indexed using the National Early Warning Score 2 and a comprehensive neuropsychological tele-battery was administered 2 years post discharge. Pearson's r correlations assessed association, while independent sample t-tests examined group differences. Significant outcomes were further analyzed using multiple regression and ANCOVAs, adjusting for key covariates. In 41 adult patients (19 female, 30 Hispanic, 13 Black, mean age of 65 (SD = 15), COVID-19 level of severity was associated with greater number of endorsed brain fog symptoms (Pearson's r = .34, 95% CI [.04, .59]), worse overall cognitive functioning (global cognition: r = -.36, 95% CI [-.61, -.05]) and reduced performance on an attention and working memory task (digit span backwards: r = -.41, 95% CI [-.66, -.09]) at 2-year follow-up. Brain fog symptoms most associated with COVID-19 severity included difficulty focusing (r = .46, 95% CI [.18, .67]), detached (r = .41, 95% CI [.12, .64]) and feeling sleepy (r = .40, 95% CI [.11, .63]). Patients' cognitive performance was generally below average (global cognition z-score: M = -.96, SD = .66), with group differences based on sex and ethnicity evidenced on individual cognitive tests. This study emphasizes the importance of continued research on the long-term effects of COVID-19 infection on neuropsychological outcomes, particularly among underrepresented, health-disparate groups. Greater understanding of these associations could improve detection and treatment of those at increased risk of cognitive decline or impairment.