Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?
Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
|
| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266652042400239X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850131826503319552 |
|---|---|
| author | Sherif Gonem Daniella Draicchio Ayad Mohamed Sally Wood Kelly Shiel Steve Briggs Tricia M McKeever Dominick Shaw |
| author_facet | Sherif Gonem Daniella Draicchio Ayad Mohamed Sally Wood Kelly Shiel Steve Briggs Tricia M McKeever Dominick Shaw |
| author_sort | Sherif Gonem |
| collection | DOAJ |
| description | Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events. |
| format | Article |
| id | doaj-art-6f4738b3c8af41cabcee5fd08e5444c4 |
| institution | OA Journals |
| issn | 2666-5204 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-6f4738b3c8af41cabcee5fd08e5444c42025-08-20T02:32:21ZengElsevierResuscitation Plus2666-52042024-12-012010078810.1016/j.resplu.2024.100788Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss?Sherif Gonem0Daniella Draicchio1Ayad Mohamed2Sally Wood3Kelly Shiel4Steve Briggs5Tricia M McKeever6Dominick Shaw7Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK; Corresponding author at: Department of Respiratory Medicine, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UKDepartment of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UKRecognise and Rescue, Nottingham University Hospitals NHS Trust, Nottingham, UKRecognise and Rescue, Nottingham University Hospitals NHS Trust, Nottingham, UKDigital and Information, Nottingham University Hospitals NHS Trust, Nottingham, UKNIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UKNIHR Leicester Biomedical Research Centre, School of Medicine, University of Leicester, Leicester, UKAim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.http://www.sciencedirect.com/science/article/pii/S266652042400239XCardiac arrestClinical deteriorationRapid response teamEarly warning scoreVital signs |
| spellingShingle | Sherif Gonem Daniella Draicchio Ayad Mohamed Sally Wood Kelly Shiel Steve Briggs Tricia M McKeever Dominick Shaw Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? Resuscitation Plus Cardiac arrest Clinical deterioration Rapid response team Early warning score Vital signs |
| title | Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? |
| title_full | Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? |
| title_fullStr | Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? |
| title_full_unstemmed | Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? |
| title_short | Physiological deterioration prior to in-hospital cardiac arrest: What does the National Early Warning Score-2 miss? |
| title_sort | physiological deterioration prior to in hospital cardiac arrest what does the national early warning score 2 miss |
| topic | Cardiac arrest Clinical deterioration Rapid response team Early warning score Vital signs |
| url | http://www.sciencedirect.com/science/article/pii/S266652042400239X |
| work_keys_str_mv | AT sherifgonem physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT danielladraicchio physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT ayadmohamed physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT sallywood physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT kellyshiel physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT stevebriggs physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT triciammckeever physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss AT dominickshaw physiologicaldeteriorationpriortoinhospitalcardiacarrestwhatdoesthenationalearlywarningscore2miss |