Original Article

Modifications of the National Early Warning Score for patients with chronic respiratory disease

Corresponding Author

N. E. Pedersen

[email protected]

orcid.org/0000-0001-9065-4427

Copenhagen Academy for Medical Education and Simulation, Centre for HR, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

Correspondence

N. E. Pedersen, Centre for HR, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Herlev, Denmark

E-mail: [email protected]

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L. S. Rasmussen,

L. S. Rasmussen

Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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J. A. Petersen,

J. A. Petersen

Department of Anaesthesia and Intensive Care, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark

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T. A. Gerds,

T. A. Gerds

Department of Public Health, University of Copenhagen, Copenhagen K, Denmark

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D. Østergaard,

D. Østergaard

Copenhagen Academy for Medical Education and Simulation, Centre for HR, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

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A. Lippert,

A. Lippert

Centre for HR, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Herlev, Denmark

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N. E. Pedersen,

Corresponding Author

N. E. Pedersen

[email protected]

orcid.org/0000-0001-9065-4427

Copenhagen Academy for Medical Education and Simulation, Centre for HR, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

Correspondence

N. E. Pedersen, Centre for HR, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Herlev, Denmark

E-mail: [email protected]

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L. S. Rasmussen,

L. S. Rasmussen

Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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J. A. Petersen,

J. A. Petersen

Department of Anaesthesia and Intensive Care, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark

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T. A. Gerds,

T. A. Gerds

Department of Public Health, University of Copenhagen, Copenhagen K, Denmark

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D. Østergaard,

D. Østergaard

Copenhagen Academy for Medical Education and Simulation, Centre for HR, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

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A. Lippert,

A. Lippert

Centre for HR, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Herlev, Denmark

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First published: 26 October 2017

https://doi.org/10.1111/aas.13020

Citations: 14

Conflicts of interest

The authors state that they have no conflicts of interest.

Funding

The study was funded by the Capital Region of Denmark. LSR and JAP received funding from the TrygFonden.

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Abstract

Background

The National Early Warning Score (NEWS) uses physiological variables to detect deterioration in hospitalized patients. However, patients with chronic respiratory disease may have abnormal variables not requiring interventions. We studied how the Capital Region of Denmark NEWS Override System (CROS), the Chronic Respiratory Early Warning Score (CREWS) and the Salford NEWS (S-NEWS) affected NEWS total scores and NEWS performance.

Methods

In an observational study, we included patients with chronic respiratory disease. The frequency of use of CROS and the NEWS total score changes caused by CROS, CREWS and S-NEWS were described. NEWS, CROS, CREWS and S-NEWS were compared using 48-h mortality and intensive care unit (ICU) admission within 48 h as outcomes.

Results

We studied 11,266 patients during 25,978 admissions; the use of CROS lowered NEWS total scores in 40% of included patients. CROS, CREWS and S-NEWS had lower sensitivities than NEWS for 48-h mortality and ICU admission. Specificities and PPV were higher. CROS, CREWS and S-NEWS downgraded, respectively, 51.5%, 44.9% and 32.8% of the NEWS total scores from the ‘mandatory doctor presence’ and ‘immediate doctor presence and specialist consultation’ total score intervals to lower intervals.

Conclusion

Capital Region of Denmark NEWS Override System was frequently used in patients with chronic respiratory disease. CROS, CREWS and S-NEWS reduced sensitivity for 48-h mortality and ICU admission. Using the methodology prevalent in the NEWS literature, we cannot conclude on the safety of these systems. Future prospective studies should investigate the balance between detection rate and alarm fatigue of different systems, or use controlled designs and patient-centred outcomes.

Supporting Information

References

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Citing Literature

Volume62, Issue2

February 2018

Pages 242-252

Filename	Description
aas13020-sup-0001-AppendixS1.docxWord document, 17.3 KB	Appendix S1. Point scoring keys.
aas13020-sup-0002-AppendixS2.docxWord document, 18.4 KB	Appendix S2. Escalation protocols.
aas13020-sup-0003-AppendixS3.docxWord document, 75.4 KB	Appendix S3. NEWS variables generating points and point-generating NEWS variables overridden by CROS.
aas13020-sup-0004-AppendixS4.docxWord document, 26.9 KB	Appendix S4. Sensitivities, specificities, positive predictive values (PPV) and negative predictive values (NPV) for trigger levels of 1–9 points, and the numbers of records at or above each trigger level, in patients with chronic respiratory disease.

Modifications of the National Early Warning Score for patients with chronic respiratory disease

Abstract

Background

Methods

Results

Conclusion

Supporting Information

References

Citing Literature

References

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Modifications of the National Early Warning Score for patients with chronic respiratory disease

Abstract

Background

Methods

Results

Conclusion

Supporting Information

References

Citing Literature

References

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