Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department
Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department
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DOI：
10.15441/ceem.19.036
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发表时间：
2020-03-01
影响因子：
1.9
通讯作者：
Youn, Chun Song
中科院分区：
文献类型：
--
作者：
Kim, Inyong;Song, Hwan;Youn, Chun Song
目的通过对危重患者生命体征的监测，建立国家早期预警评分（NEWS），以监测危重患者的临床恶化，降低院内心脏骤停的发生率。然而，尽管基于生命体征的死亡率预测在老年患者中可能是困难的，但NEWS在这一人群中的有效性尚未得到评估。本研究旨在验证入院时NEWS升高会增加急诊科（艾德）老年患者死亡风险的假设。方法我们进行了一项单中心回顾性研究，包括2016年11月至2017年2月期间入住艾德的患者。我们纳入了年龄> 65岁的患者，他们因任何医疗问题而入住艾德。在艾德入院时计算NEWS。主要结果为住院死亡率。结果共有3,169例患者纳入本研究。中位年龄为75岁（四分位距[IQR]，70 - 80岁），1，557例（49.1%）患者为男性。住院死亡率为5.1%（161例患者）。非存活者的NEWS中位数高于存活者（5 [IQR，3 - 8] vs. 1 [IQR，0 - 3]，P <0.001）。多变量logistic分析显示，调整其他混杂因素后，NEWS与住院死亡率相关。NEWS预测住院病死率的曲线下面积为0.820（95%可信区间0.806~0.833）。结论在65岁以上老年患者中，入院时NEWS与住院病死率相关。
Objective The National Early Warning Score (NEWS), based on the patients' vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED).Methods We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged > 65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality.Results In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3-8] vs. 1 [IQR, 0-3], P< 0.001). Multivariate logistic analysis showed that the NEWS was associated with in-hospital mortality, after adjusting for other confounders. The area under the curve of the NEWS for predicting in-hospital mortality was 0.820 (95% confidence interval, 0.806 to 0.833).Conclusion Our results show that the NEWS at admission is associated with in-hospital mortality among patients aged > 65 years.