University of Oulu

Kemp, K., Alakare, J., Harjola, VP. et al. National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med 20, 83 (2020). https://doi.org/10.1186/s12873-020-00379-y

National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

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Author: Kemp, Kirsi1,2; Alakare, Janne1,2; Harjola, Veli-Pekka1,2;
Organizations: 1Emergency Medicine, Helsinki University, Helsinki, Finland
2Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
3University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
4University of Oulu, Center for Life Course Health Research, Oulu, Finland
5Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.7 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe202102023512
Language: English
Published: Springer Nature, 2020
Publish Date: 2021-02-02
Description:

Abstract

Background: The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED.

Methods: This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥ 75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-h and 30-day revisits, and ED length-of-stay (LOS).

Results: A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 h and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU.

With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64–0.76) and 0.62 (0.56–0.68); for hospital admission prediction 0.62 (0.60–0.65) and 0.55 (0.52–0.56), and for HDU admission 0.72 (0.61–0.83) and 0.80 (0.70–0.90), respectively.

The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p = 0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p < 0.001) but not between the yellow/green groups (p = 0.59).

There were 48 and 351 revisits within 72 h and 30 days, respectively. With NEWS2 AUCs for 72-h and 30-day revisit prediction were 0.48 (95% CI 0.40–0.56) and 0.47 (0.44–0.51), respectively; with triage score 0.48 (0.40–0.56) and 0.49 (0.46–0.52), respectively.

Conclusions: The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission.

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Series: BMC emergency medicine
ISSN: 1471-227X
ISSN-E: 1471-227X
ISSN-L: 1471-227X
Volume: 20
Issue: 1
Article number: 83
DOI: 10.1186/s12873-020-00379-y
OADOI: https://oadoi.org/10.1186/s12873-020-00379-y
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Funding: The study was funded with State funding for university-level health research from Helsinki University Hospital (funding for JA, KK salaries during the preparation, data collection and analysis, funding for supporting personnel salaries and minor miscellaneous expenses) and funding from Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital (funding for JA, KK salaries during the preparation, data collection and analysis and the open access publication fee). Authors JA and KK have received grants the Finnish Association for Emergency Medicine and JA also from The Finnish Medical Foundation as compensation for study expenses (reduced salary during the research period, expenses due to publishing and reporting).
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