Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

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

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Hypothermic to ischemic ratio and mortality in post-cardiac arrest patients

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Response letter to comments made by J. G. Förster, M. Pitkänen

    Research output: Contribution to journalLetterResearchpeer-review

  3. APACHE II score validation in emergency abdominal surgery. A post hoc analysis of the InCare trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Social ties influence teamwork when managing clinical emergencies

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Abnormal routine blood tests as predictors of mortality in acutely admitted patients

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

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.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Volume62
Issue number2
Pages (from-to)242-252
Number of pages10
ISSN0001-5172
DOIs
Publication statusPublished - 2018

    Research areas

  • Journal Article

ID: 51963544