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Research

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 and Daniel Lasserson
BJGP Open 2020; 4 (2): bjgpopen20X101071. DOI: https://doi.org/10.3399/bjgpopen20X101071
Matthew Inada-Kim
1 Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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Thomas Knight
2 Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
3 Department of Acute Medicine, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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  • For correspondence: thomasknight@nhs.net
Michelle Sullivan
4 South Central Ambulance Service NHS Foundation Trust, Bicester, UK
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Mark Ainsworth-Smith
5 Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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Neil Pike
6 NHS West Hampshire Clinical Commissioning Group, Eastleigh, UK
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Mathew Richardson
1 Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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Gail Hayward
7 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Daniel Lasserson
2 Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
3 Department of Acute Medicine, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Article Figures & Data

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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

Tables

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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) 
    Frailty20.8 (234)10.6 (239)
    Dementia15.2 (171)7.5 (169)
    ReSPECT form29.0 (327)17.9 (403)
    Receiving chemotherapy3.2 (36)2.5 (56)
    Receiving specialist palliative care13.1 (148)7.5 (169)
    Death at5 days3.6 (41)1.9 (43)
    Death or critical care at 5 days5.2 (59)3.2 (72)
    Death at30 days11.7 (132)5.8 (131)
    Death or critical care at 30 days13.5 (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 outcome30 day outcome
    NEWS ≥5NEWS ≥7NEWS ≥5NEWS ≥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
    Sensitivity49%(33-65)38%(31-47)21%(10-36)25%(18-33)37%(29-46)37%(30-45)23%(16-31)24%(18-32)
    Specificity83%(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 value5%(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 value99%(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 ratio2.8(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 ratio0.6(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
    Sensitivity62%(46-77)53%(45-62)42%(27-59)32%(24-40)54%(45-62)53%(45-61)24%(18-30)31%(24-39)
    Specificity67%(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 value7%(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 value98%(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 ratio1.9(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 ratio0.6(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)
    • NEWS = national early warning scores.

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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
BJGP Open 2020; 4 (2): bjgpopen20X101071. DOI: 10.3399/bjgpopen20X101071

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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
BJGP Open 2020; 4 (2): bjgpopen20X101071. DOI: 10.3399/bjgpopen20X101071
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Keywords

  • Early warning score
  • Continuity of care
  • Patient safety
  • Hospital referrals
  • secondary care
  • retrospective studies
  • Critical care
  • Hospitalization
  • primary health care

More in this TOC Section

  • How does decontextualised risk information affect clinicians understanding of risk and uncertainty in primary care diagnosis? A qualitative study of clinical vignettes
  • Declining number of home visits to older adults by GPs: an observational study using data from electronic health records in The Netherlands, 2017–2023
  • What’s been tried: a curated catalogue of efforts to improve access to general practice
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