The prognostic value of national early warning scores (NEWS) during transfer of care from community settings to hospital: a retrospective service evaluation

Matthew Inada-Kim; Thomas Knight; Michelle Sullivan; Mark Ainsworth-Smith; Neil Pike; Mathew Richardson; Gail Hayward; Daniel Lasserson

doi:10.3399/bjgpopen20X101071

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Figure 1. Flow diagram demonstrating study population.
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Figure 2. Proportion of total primary care referrals with a NEWS recorded at the point of referral across the evaluation period.
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Figure 3. Adverse outcomes stratified by source of NEWS and risk group

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Table 1. Demographics of cohort

	Referrals from primary care
Demographic	NEWS recorded by ambulance, % (n) (n = 1 126 )	NEWS recorded at point of referral, % (n) (n = 2252)
Mean age, years (SD)	76 (15)	65 (21)
Frailty	20.8 (234)	10.6 (239)
Dementia	15.2 (171)	7.5 (169)
ReSPECT form	29.0 (327)	17.9 (403)
Receiving chemotherapy	3.2 (36)	2.5 (56)
Receiving specialist palliative care	13.1 (148)	7.5 (169)
Death at5 days	3.6 (41)	1.9 (43)
Death or critical care at 5 days	5.2 (59)	3.2 (72)
Death at30 days	11.7 (132)	5.8 (131)
Death or critical care at 30 days	13.5 (152)	7.3 (164)

ReSPECT form = Recommended Summary Plan for Emergency Treatment form.

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Table 2. Summary of diagnostic performance of NEWS to predict adverse outcome

	5 day outcome	30 day outcome
	NEWS ≥5	NEWS ≥7	NEWS ≥5	NEWS ≥7
	Death (95% CI)	Death or critical care admission (95% CI)	Death (95% CI)	Death or critical care admission (95% CI)	Death (95% CI)	Death or critical care admission (95% CI)	Death (95% CI)	Death or critical care admission (95% CI)
NEWS recorded by GP
Sensitivity	49%(33-65)	38%(31-47)	21%(10-36)	25%(18-33)	37%(29-46)	37%(30-45)	23%(16-31)	24%(18-32)
Specificity	83%(81-84)	84%(82-85)	93%(91-94)	94%(92-95)	83%(82-85)	84%(82-85)	93%(92-94)	94%(92-95)
Positive predictive value	5%(3-8)	15%(12-19)	5%(2-10)	22%(16-29)	12%(9-16)	15%(12-19)	17%(12-24)	23%(17-30)
Negative predictive value	99%(98-99)	95%(94-96)	98%(98-99)	94%(93-95)	96%(95-96)	94%(93-95)	95%(94-96)	94%(93-95)
Positive likelihood ratio	2.8(2.1–3.9)	2.3(1.9–2.9)	2.8(1.5–5.1)	3.9(2.8–5.3)	2.2(1.8–2.8)	2.3(1.8–2.8)	3.4(2.4–4.8)	3.8(2.8–5.2)
Negative likelihood ratio	0.6(0.5–0.8)	0.7(0.7–0.8)	0.9(0.7–1.0)	0.8(0.7–0.9)	0.8(0.7–0.9)	0.8(0.7–0.9)	0.8(0.8–0.9)	0.8(0.7–0.9)
NEWS recorded by ambulance
Sensitivity	62%(46-77)	53%(45-62)	42%(27-59)	32%(24-40)	54%(45-62)	53%(45-61)	24%(18-30)	31%(24-39)
Specificity	67%(64-70)	69%(66-72)	85%(83-87)	86%(84-88)	69%(66-72)	69%(66-72)	86%(84-88)	86%(84-88)
Positive predictive value	7%(4-10)	21%(17-25)	9%(6-15)	26%(20-33)	19%(15-23)	21%(17-26)	24%(18-30)	26%(20-33)
Negative predictive value	98%(97-99)	91%(88-93)	98%(96-98)	89%(87%–91%)	92%(90-94)	90%(88-92)	86%(84-88)	89%(87-91)
Positive likelihood ratio	1.9(1.5–2.5)	1.7(1.4–2.1)	2.8(1.9–4.1)	2.3(1.7–3.1)	1.7(1.4–2.1)	1.7(1.5–2.1)	1.7(1.3–2.3)	2.2(1.7–3.0)
Negative likelihood ratio	0.6(0.4–0.8)	0.7(0.6–0.8)	0.7(0.5–0.9)	0.8(0.7–0.9)	0.7(0.6–0.8)	0.7(0.6–0.8)	0.9(0.8–1.0)	0.8(0.7-.0.9)