Cargando…
Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study
OBJECTIVES: The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan. DESIGN: This retrospective study assessed patients and calculated the NEWS from paramed...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299041/ https://www.ncbi.nlm.nih.gov/pubmed/32546488 http://dx.doi.org/10.1136/bmjopen-2019-034602 |
_version_ | 1783547324871475200 |
---|---|
author | Endo, Takuro Yoshida, Toru Shinozaki, Tomohiro Motohashi, Takako Hsu, Hsiang-Chin Fukuda, Shunsuke Tsukuda, Jumpei Naito, Takaki Morisawa, Kenichiro Shimozawa, Nobuhiko Taira, Yasuhiko Fujitani, Shigeki |
author_facet | Endo, Takuro Yoshida, Toru Shinozaki, Tomohiro Motohashi, Takako Hsu, Hsiang-Chin Fukuda, Shunsuke Tsukuda, Jumpei Naito, Takaki Morisawa, Kenichiro Shimozawa, Nobuhiko Taira, Yasuhiko Fujitani, Shigeki |
author_sort | Endo, Takuro |
collection | PubMed |
description | OBJECTIVES: The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan. DESIGN: This retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury. SETTING: A tertiary hospital in Japan. PARTICIPANTS: Overall, 2847 patients transported by ambulance between April 2017 and March 2018 were included. RESULTS: The mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 6.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 11.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively. CONCLUSION: The findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition. |
format | Online Article Text |
id | pubmed-7299041 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-72990412020-06-22 Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study Endo, Takuro Yoshida, Toru Shinozaki, Tomohiro Motohashi, Takako Hsu, Hsiang-Chin Fukuda, Shunsuke Tsukuda, Jumpei Naito, Takaki Morisawa, Kenichiro Shimozawa, Nobuhiko Taira, Yasuhiko Fujitani, Shigeki BMJ Open Emergency Medicine OBJECTIVES: The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan. DESIGN: This retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury. SETTING: A tertiary hospital in Japan. PARTICIPANTS: Overall, 2847 patients transported by ambulance between April 2017 and March 2018 were included. RESULTS: The mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 6.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 11.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively. CONCLUSION: The findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition. BMJ Publishing Group 2020-06-15 /pmc/articles/PMC7299041/ /pubmed/32546488 http://dx.doi.org/10.1136/bmjopen-2019-034602 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Emergency Medicine Endo, Takuro Yoshida, Toru Shinozaki, Tomohiro Motohashi, Takako Hsu, Hsiang-Chin Fukuda, Shunsuke Tsukuda, Jumpei Naito, Takaki Morisawa, Kenichiro Shimozawa, Nobuhiko Taira, Yasuhiko Fujitani, Shigeki Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title_full | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title_fullStr | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title_full_unstemmed | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title_short | Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study |
title_sort | efficacy of prehospital national early warning score to predict outpatient disposition at an emergency department of a japanese tertiary hospital: a retrospective study |
topic | Emergency Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299041/ https://www.ncbi.nlm.nih.gov/pubmed/32546488 http://dx.doi.org/10.1136/bmjopen-2019-034602 |
work_keys_str_mv | AT endotakuro efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT yoshidatoru efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT shinozakitomohiro efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT motohashitakako efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT hsuhsiangchin efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT fukudashunsuke efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT tsukudajumpei efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT naitotakaki efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT morisawakenichiro efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT shimozawanobuhiko efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT tairayasuhiko efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy AT fujitanishigeki efficacyofprehospitalnationalearlywarningscoretopredictoutpatientdispositionatanemergencydepartmentofajapanesetertiaryhospitalaretrospectivestudy |