Page 10 - HTA REPORT: NATIONAL EARLY WARNING SCORE

Effectiveness

xii 1. Discriminative Ability and Predictive Validity

NEWS

There was a substantial fair level of evidence to suggest;

Emergency department

v vThe NEWS was an effective assessment tool to identify and triage the patient for
the most appropriate acute care assessments and interventions.
v vThe NEWS was a good predictor for serious adverse events (mortality and
unanticipated ICU admission) in adult patients of varying severity of illness
presenting to emergency department. It was able to rapidly predict prognosis
and evaluate disease progression of critical patients in resuscitation room.
v vThe performance of NEWS was superior than quick Sequential Organ Failure
Assessment (qSOFA), Systemic Inflammatory Response Sydrome criteria
(SIRS) and Modified Early Warning score (MEWS), in risk-stratifying patients
NATIONAL EARLY
WARNING SCORE (NEWS)
with suspected infection or sepsis and predicting death and unanticipated ICU
admission in this subpopulation. Table-based aggregate weighted systems, such
as NEWS, were more predictive and robust compared with tally-based single
parameter scores such as qSOFA and SIRS.
v vHowever, NEWS may not be the optimum scoring system for all patient
subgroups. The NEWS showed moderate predictive ability for patient with
community acquired pneumonia and low accuracy for in-hospital mortality in
critically ill geriatric patients.

General wards

v vThe NEWS assessed on ward admission was able to risk stratify clinical
deterioration and a good predictor of in-hospital serious adverse outcomes.
v vNEWS discriminates high risk patients in a heterogenic general ward population
HEALTH TECHNOLOGY ASSESSMENT REPORT
HEALTH TECHNOLOGY ASSESSMENT SECTION (MaHTAS)
MEDICAL DEVELOPMENT DIVISION, MINISTRY OF HEALTH
independently of multiple confounding factors (age, gender, cumulative
comorbidity, admission characteristic).
v vThe NEWS outperformed 33 other widely used Early Warning Scores (EWSs)
for combined outcome of death, cardiac arrest and unanticipated ICU admission
within 24 hours in the general population of patients.
v vBetween non-elective surgical patients and non-elective medical patients, NEWS
had almost equal discriminative ability for prediction of serious adverse events.
v vThe NEWS accurately discriminates patients at risk of death, admission to the
intensive care unit, or cardiac arrest within a 24-hour period for a range of liver-
related diagnoses.
v vA local study showed that NEWS was able to independently predict death or
unanticipated ICU admission with an excellent prognostic performance (AUROC
0.905, p<0.001) in general surgical and orthopaedic wards. A score of 5 or more
had the optimal sensitivity (87%) and specificity (91.3%) with PPV of 26.9% to
predict serious adverse events in general ward (OR 2.828; 95%CI 1.632, 4.902).
The number needed to screen at this threshold was 3.6.
v vNational Early Warning Score was identified as independent predictor of early
clinical deterioration 24 hours after ICU discharge and readmission to ICU
or High Dependency Unit (HDU). A NEWSdc > 7 showed the best sensitivity
(93.6%) and specificity (82.2%) to detect early clinical deterioration 24 hours
after ICU discharge.
v vThe NEWS also had reasonable discrimination for any ICU patient’s discharge
location within 24 hours of admission to any ICU specialty. Hence, it could
potentially be applied within a universal discharge planning tool for ICU,
improving patient safety at the point of discharge (reduce the likelihood of both