Page 11 - HTA REPORT: NATIONAL EARLY WARNING SCORE

premature discharge and discharge delay by allowing care providers adequate
time to plan accordingly).
v vHowever, the NEWS system, whilst beneficial, lacks sensitivity and specificity in xiii
subpopulations of older adult patients (with/without comorbidity, high frailty
index), patients with chronic obstructive pulmonary diseases (COPD) and
oncology patients at risk of deterioration.

Pre-hospital setting

v vIn pre-hospital setting whereby NEWS was calculated using parameters recorded
on the scene or prior ambulance transfer, NEWS showed good discriminative
performance for both short term and long term mortality, and ICU admission HEALTH TECHNOLOGY ASSESSMENT REPORT HEALTH TECHNOLOGY ASSESSMENT SECTION (MaHTAS) MEDICAL DEVELOPMENT DIVISION, MINISTRY OF HEALTH
from ED.
v vA threshold level of 7 was associated with increased risk for the combined
outcome of death or critical care unit escalation within 48 hours of hospital
admission.
v vPre-hospital NEWS had better diagnostic accuracy in cases where the initial
dispatch code was specified as trauma.
v vPre-hospital NEWS had poor prognostic performance for in-hospital mortality
in elderly patients.
v vAmong pre-hospital patients with suspected infection, an elevated NEWS, was
associated with increased levels of adverse outcomes (ICU admission within 48
hours of presentation and/ or 30-day mortality). The aggregated total NEWS NATIONAL EARLY
score was, significantly superior to qSOFA at identifying patients at combined
risk. A NEWS of medium or high clinical risk could be used according to sepsis WARNING SCORE (NEWS)
guideline to prompt clinicians to further investigate for organ dysfunction, to
initiate or escalate therapy as appropriate, and to consider referral to critical
care or increase the frequency of monitoring.

NEWS2

v vIn predicting 24 hours mortality among patients with documented or at risk
of type 2 respiratory failure, NEWS2 did not show superior performance to
original NEWS. The NEWS2 did not improve discrimination for unanticipated
ICU admission, cardiac arrest or combined outcomes compared to NEWS either.
v vIn acute exacerbation of chronic obstructive pulmonary disease (AECOPD)
cohort, NEWS2 at admission did not outperform the original NEWS.
v vIn pre-hospital setting, NEWS2 had the best prognostic performance [AUROC
of 0.896 (95%CI 0.82, 0.95)], in comparison with other EWS namely EWS [Early
Warning Score (EWS), Modified Early Warning Score (MEWS), Vital-PAC Early
Warning Score (ViEWS), Hamilton Early Warning Score (HEWS) and Scottish
Early Warning Score (SEWS).
v vThe NEWS2 accurately predicted in-hospital mortality particularly among
patients with suspected infection. At the critical threshold (≥ 5), the NEWS2 had
sensitivity of 84.5% (95%CI 82.8, 86.2) and specificity of 49.0% (95%CI 47.4, 50.7).
The number needed to examine (NNE) was 2.20 (95%CI 2.16, 2.25). NEWS2 was
superior to qSOFA for screening for sepsis with organ dysfunction, infection-
related mortality or intensive care due to an infection both among infected
patients and among undifferentiated patients at emergency departments.

2. Impact on clinical outcome (NEWS and NEWS2)
v
v Despite having good prognostic performance of death and ICU admission, the
implementation of NEWS has not yet been reported to have any change in overall
patient outcomes (survival rate, serious adverse events rate, ICU mortality rate).