Use of National Early Warning Score for observation for increased risk for clinical deterioration during post-ICU care at a surgical ward

Figures & data

Table 1 National Early Warning Score

Physiological parameters	3	2	1	0	1	2	3
Respiratory rate, x/min	≤8		9–11	12–20		21–24	≥25
Oxygen saturation, %	≤91	92–93	94–95	≥96
Oxygen supplement		Yes		No
Temperature, °C	≤35.5		35.1–36.0	36.1–38.0	38.1–39.0	≥39.1
Systolic blood pressure, mmHg	≤90	91–100	101–110	111–219			≥220
Heart rate, x/min	≤40		41–50	51–90	91–110	111–130	≥131
Level of consciousness, AVPU scale				A			V, P or U

Notes: Reprinted from Royal College of Physicians. National Early warning score (news): standardising the assessment of acute-illness severity in the NHS. Report of a working Party. London: RCP; 2012. © Royal College of Physicians 2012.¹³

Abbreviation: AVPU, alert, voice, pain, unresponsive.

Figure 1 Flowchart shows patient exclusion process.

Abbreviations: ICU, intensive care unit; NEWS, National Early Warning Score.

Table 2 Clinical characteristics and treatment details of 124 patients included in study

Variables	Total (N=124)
Mean age (SD)	65.9 (14.5)
Male gender (%)	74 (59.9)
Mean SAPSII (SD)	33.8 (12.7)
Median length of stay ICU, days (min, max)	1.5 (0.04, 30.8)
Respiratory support (%)	63 (50.8)
Continuous veno-venous hemodiafiltration (%)	2 (1.6)
Tracheostomy (%)	4 (3.2)
Mean NEWS at ICU discharge (SD)	2.7 (1.9)
Mean NEWS at outcome (SD)	1.8 (2.6)

Abbreviations: ICU, intensive care unit; NEWS, National Early Warning Score; SAPSII, Simplified Acute Physiology Score.

Table 3 Clinical characteristics of readmitted to ICU/HDU and non-readmitted groups

Variables	Readmitted ICU/HDU (N=20)	Not readmitted (N=104)	P-value
Mean age (SD)	71.8 (11.2)	64.8 (14.8)	0.044a
Male gender (%)	14 (70.0)	60 (57.7)	0.304b
Mean SAPSII (SD)	39.4 (12.0)	32.8 (12.6)	0.031a
Median length of stay ICU, days (min, max)	2.33 (0.04, 24.4)	1.43 (0.08, 30.8)	0.401c
Respiratory support (%)	12 (60.0)	51 (49.0)	0.369b
Continuous veno-venous hemodiafiltration (%)	1 (5, 0)	1 (1, 0)	0.189b
Tracheostomy (%)	1 (5, 0)	3 (2, 9)	0.624b
Mean NEWS at ICU discharge (SD)	3.7 (2.1)	2.5 (1.8)	0.01a
Mean NEWS at outcome (SD)	6.0 (3.2)	1.0 (1.5)	<0.001a

Notes:

a Independent sample t-test.

b Chi-squared test.

c Mann–Whitney test.

Abbreviations: HDU, high dependency unit; ICU, intensive care unit; NEWS, National Early Warning Score; SAPSII, Simplified Acute Physiology Score.

Table 4 Multivariate logistic regression model of predictors associated with clinical deterioration and readmission to the ICU/HDU

Variables	OR	95% CI	P-value
Age	1.03	0.98–1.07	0.26
SAPSII	1.03	0.99–1.07	0.16
NEWS at ICU discharge	1.32	1.01–1.72	0.04

Abbreviations: ICU, intensive care unit; NEWS, National Early Warning Score; SAPSII, Simplified Acute Physiology Score.

Figure 2 Sequence plot of maximum NEWS – first 30 days.

Notes: Patients not readmitted to the ICU/HDU are demonstrated in (A), and patients readmitted to the ICU/HDU are demonstrated in (B). There is one line per patient demonstrating the sequence of maximum NEWS score in each 6-hour period.
Abbreviations: HDU, high dependency unit; ICU, intensive care unit; NEWS, National Early Warning Score.

Figure 3 Locally Weighted Scatterplot Smoothing plot of the development of NEWS score for the last 180 hours before the ICU/HDU readmission or ward discharge was experienced.

Notes: (A) Patients readmitted to the ICU/HDU. (B) Patients not readmitted to the ICU/HDU.
Abbreviations: HDU, high dependency unit; ICU, intensive care unit; NEWS, National Early Warning Score.

Table 5 Linear mixed effect model – change in mean NEWS score

Parameters – fixed effects	Model parameter	Coef.	95% CI	P-value
Intercept baseline	β0	2.59	(2.29–2.89)	<0.001
Time effect (hours)	β1	−0.009	(−0.01 to –0.007)	<0.001
Intercept – outcome group	β2	1.11	(0.35–1.87)	0.004
Interaction time (hours) vs group	β3	0.024	(0.02–0.03)	<0.001
Parameters – random effects
Variance random intercepts	b0,1	2.21	(1.67–2.93)
Variance random slopes	b1,j	0.00008	(0.00006–0.00013)
Variance residual	εi,j	1.56	(1.48–1.64)
Covariance (b0,1, b1,j)		−0.0042	(−0.0079 to −0.00053)

Notes: Model: y_i,j=β₀ + β₁ × time + β₂ × group + β₃ × time × group + b_0,1 + b_1,j × time + ε_i,j. Restriced Maximum Likelihood (REML) was estimated.

Abbreviations: Coef., coefficient; NEWS, National Early Warning Score.

Royal College of PhysiciansNational Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHSReport of a Working PartyLondonRCP2012

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