University of Oulu

Hoikka, M., Silfvast, T., Ala-Kokko, T. (2018) Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients?. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26, 48. doi:10.1186/s13049-018-0514-1

Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients?

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Author: Hoikka, Marko1; Silfvast, Tom2; Ala-Kokko, Tero I.1
Organizations: 1University of Oulu, Medical Research Centre, Research Unit of Surgery, Anaesthesia and Intensive Care and Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital
2University of Helsinki and Department of Anaesthesiology and Intensive Care, Helsinki University Central Hospital
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2018-09-07


Objectives: The prehospital research field has focused on studying patient survival in cardiac arrest, as well as acute coronary syndrome, stroke, and trauma. There is little known about the overall short-term mortality and its predictability in unselected prehospital patients. This study examines whether a prehospital National Early Warning Score (NEWS) predicts 1-day and 30-day mortalities.

Methods: Data from all emergency medical service (EMS) situations were coupled to the mortality data obtained from the Causes of Death Registry during a six-month period in Northern Finland. NEWS values were calculated from first clinical parameters obtained on the scene and patients were categorized to the low, medium and high-risk groups accordingly. Sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and likelihood ratios (PLRs and NLRs) were calculated for 1-day and 30-day mortalities at the cut-off risks.

Results: A total of 12,426 EMS calls were included in the study. The overall 1-day and 30-day mortalities were 1.5 and 4.3%, respectively. The 1-day mortality rate for NEWS values ≤12 was lower than 7% and for values ≥13 higher than 20%. The high-risk NEWS group had sensitivities for 1-day and 30-day mortalities 0.801 (CI 0.74–0.86) and 0.42 (CI 0.38–0.47), respectively.

Conclusion: In prehospital environment, the high risk NEWS category was associated with 1-day mortality well above that of the medium and low risk NEWS categories. This effect was not as noticeable for 30-day mortality. The prehospital NEWS may be useful tool for recognising patients at early risk of death, allowing earlier interventions and responds to these patients.

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Series: Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
ISSN-E: 1757-7241
ISSN-L: 1757-7241
Volume: 26
Article number: 48
DOI: 10.1186/s13049-018-0514-1
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The study was funded by an Oulu University Hospital EVO grant.
Copyright information: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.